(Circulation. 1995;92:734-740.)
© 1995 American Heart Association, Inc.
Articles |
Predictors and Sequelae of Distal Embolization During Saphenous Vein Graft Intervention From the CAVEAT-II Trial
From the Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, Ohio (J.L., E.J.T.); the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn (D.R.H.); the Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (R.M.C., K.P., G.K.); and the Division of Cardiology, William Beaumont Hospital, Royal Oak, Mich (R.D.S.).
Correspondence to Eric J. Topol, MD, Department of Cardiology, One Clinic Center, Cleveland Clinic Foundation, Cleveland, OH 44195.
Background The purpose of this study was to identify the predictors and sequelae of distal embolization from a multicenter, randomized trial of saphenous vein graft intervention. The CAVEAT-II trial demonstrated that saphenous vein graft directional coronary atherectomy (DCA) was associated with greater angiographic success and less need for repeat intervention compared with percutaneous transluminal coronary angioplasty (PTCA) but at the cost of more acute complications—notably distal embolization.
Methods and Results In CAVEAT-II, 305 patients were randomly
assigned to DCA (149 patients) or PTCA (156 patients) for lesions with
>60% diameter stenosis in vein grafts 
3 mm in diameter.
Distal embolization occurred in 20 patients (13.4%) assigned to DCA
and 8 patients (5.1%) assigned to PTCA (P=.011).
Independent predictors of distal embolization were use of DCA (71% in
distal embolization patients versus 47% in patients without distal
embolization, P=.011) and presence of thrombus (39% in
distal embolization patients versus 14% in patients without distal
embolization, P<.00). In-hospital adverse events were more
frequent after distal embolization: 71% versus 20%, odds ratio plus
(95% confidence intervals) 9.87 (4.65, 20.94). At 12-month follow-up,
adverse event rates were also higher in patients with distal
embolization (odds ratio, 3.05 [1.95, 4.76]).
Conclusions In this first prospective multicenter trial of saphenous vein graft intervention, distal embolization was more common after DCA than PTCA and in lesions containing thrombus. It also was associated with worse in-hospital and 12-month outcomes. The risk and sequelae of distal embolization should be considered when choosing a treatment strategy for vein graft disease.
Key Words: embolism • angioplasty
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