Release and elimination of soluble vasoactive factors during percutaneous coronary intervention of saphenous vein grafts: analysis using the PercuSurge GuardWire distal protection device

Abstract

Background: The presence of no-reflow substantially increases the risk of major adverse clinical events (MACE) in percutaneous coronary artery interventions (PCI). Distal protection devices may eliminate both debris and soluble factors that can lead to no-reflow. This study was designed to evaluate the soluble factors released and eliminated by the PercuSurge GuardWire during SVG intervention.

Methods: Twenty-eight consecutive patients underwent PCI on 34 lesions in 31 SVGs using the PercuSurge GuardWire. Blood was taken prior to PCI for baseline measurement of: (1) vasoconstrictive factors: endothelin (ET) and serotonin (5-HT); (2) thrombotic factors: tissue factor (TF), plasminogen activator inhibitor (PAI-1), thrombin/antithrombin III complex (TAT), and prothrombin fragment F1+2 (F1+2); and (3) inflammatory factors: soluble CD40 ligand (sCD40L) and soluble E-selectin. After stenting and before deflating the distal protection balloon, 2 aspiration runs were performed with the PercuSurge Export Catheter and sent for analysis.

Results: Clinical follow-up was conducted at an average of 6 +/- 3 months. SVG PCI resulted in a substantial increase in levels of vasoconstrictive factors, including ET (3 x increase; p < 0.001) and 5-HT (9.7 x increase; p = 0.031); thrombotic factors, including TF (4.5 x increase; p = 0.005), TAT (2.4 x increase; p < 0.001), and F1+2 (2.4 x increase; p < 0.001). Pro-inflammatory factors were also released during the procedure. Levels of sCD40L and soluble E-selectin increased 123% (p = 0.003) and 25% (p < 0.001), respectively.

Conclusions: SVG PCI results in an immediate increase in vasoactive factors, including vasoconstrictive, thrombotic and inflammatory factors. The PercuSurge GuardWire effectively removes these soluble factors, which may account for reduction of no-reflow and other complications during SVG interventions.