Cardiovascular Revascularization Medicine 16 (2015) 62
Contents lists available at ScienceDirect
Cardiovascular Revascularization Medicine
Letter to the Editor
Another option for embolic protection: suck-u-surge Richard R. Heuser Phoenix Heart Center/St. Luke's Medical Center
To The Editor: We read with interest Dr. García-Tejada's article [1] in regard to utilization of guiding catheter thrombectomy combined with an embolic protection device. As has been shown with a randomized trial looking at saphenous vein graft embolic protection [2], embolic protection is necessary for saphenous vein graft work. However, in some cases embolic protection cannot be utilized. We agree with García-Tejada's article that guiding catheter thrombectomy is one useful and easy technique to remove thrombus. Another technique has been utilized by our group for over 10 years in over 200 saphenous vein, coronary and carotid interventions using what we call a suck-u-surge technique. We originally described this in 2002 [3] (Figs. 1–2). In cases where there clearly is thrombus, it is not sufficient to just use a filter, you might consider thrombus aspiration. Dr. García-Tejada's article shows an excellent and easy technique in complex intervention to remove the thrombus and reduce embolic phenomenon. Our technique may also be utilized to address complicated saphenous vein graft lesions with deployment of a stent with suction performed during the intervention [3–7].
[1] García-Tejada J, Jurado-Román A, Hernandez F, Asenjo RM, de Nicolás JMM, Albarrán A, et al. Guiding-catheter thrombectomy combined with distal protection during primary percutaneous coronary intervention of a saphenous vein graft. Cardiovasc Revasc Med 2013;14:356–8. [2] Baim DS, Wahr D, George B, Leon MB, Greenberg J, Cutlip DE, et al. Saphenous veing graft angioplasty free of emboli randomized SAFER) Trial Investigators. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation 2002; 105(11):1285–90. [3] Morales PA, Heuser RR. Guiding catheter aspiration to prevent embolic events during saphenous vein graft intervention. J Interv Cardiol 2002;15:491–8. [4] Cragun D, Heuser RR. Embolic protection devices in saphenous vein graft interventions. J Interv Cardiol 2006;19:525–9. [5] Heuser RR. Letter to the editor. Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the Stent of Saphenous Vein Grafts Trial. Catheter Cardiovasc Interv 2011;77:594. [6] Suck-u-surge revisited. Vasc Dis Manag Blog May 2011. [7] Suck-u-surge via the radial route. Vasc Dis Manag Blog August 2011.
Fig. 1. The important aspect of the technique is to make sure the guiding catheter is firmly intubated in the treated vessel. In this figure, the stent has been placed at the site of the lesion.
Fig. 2. A stent is deployed with simple negative suction performed simultaneously.
http://dx.doi.org/10.1016/j.carrev.2014.12.003 1553-8389/© 2014 Elsevier Inc. All rights reserved.
References
Contents lists available at ScienceDirect
Cardiovascular Revascularization Medicine
Letter to the Editor
Another option for embolic protection: suck-u-surge Richard R. Heuser Phoenix Heart Center/St. Luke's Medical Center
To The Editor: We read with interest Dr. García-Tejada's article [1] in regard to utilization of guiding catheter thrombectomy combined with an embolic protection device. As has been shown with a randomized trial looking at saphenous vein graft embolic protection [2], embolic protection is necessary for saphenous vein graft work. However, in some cases embolic protection cannot be utilized. We agree with García-Tejada's article that guiding catheter thrombectomy is one useful and easy technique to remove thrombus. Another technique has been utilized by our group for over 10 years in over 200 saphenous vein, coronary and carotid interventions using what we call a suck-u-surge technique. We originally described this in 2002 [3] (Figs. 1–2). In cases where there clearly is thrombus, it is not sufficient to just use a filter, you might consider thrombus aspiration. Dr. García-Tejada's article shows an excellent and easy technique in complex intervention to remove the thrombus and reduce embolic phenomenon. Our technique may also be utilized to address complicated saphenous vein graft lesions with deployment of a stent with suction performed during the intervention [3–7].
[1] García-Tejada J, Jurado-Román A, Hernandez F, Asenjo RM, de Nicolás JMM, Albarrán A, et al. Guiding-catheter thrombectomy combined with distal protection during primary percutaneous coronary intervention of a saphenous vein graft. Cardiovasc Revasc Med 2013;14:356–8. [2] Baim DS, Wahr D, George B, Leon MB, Greenberg J, Cutlip DE, et al. Saphenous veing graft angioplasty free of emboli randomized SAFER) Trial Investigators. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation 2002; 105(11):1285–90. [3] Morales PA, Heuser RR. Guiding catheter aspiration to prevent embolic events during saphenous vein graft intervention. J Interv Cardiol 2002;15:491–8. [4] Cragun D, Heuser RR. Embolic protection devices in saphenous vein graft interventions. J Interv Cardiol 2006;19:525–9. [5] Heuser RR. Letter to the editor. Contemporary use of embolic protection devices in saphenous vein graft interventions: Insights from the Stent of Saphenous Vein Grafts Trial. Catheter Cardiovasc Interv 2011;77:594. [6] Suck-u-surge revisited. Vasc Dis Manag Blog May 2011. [7] Suck-u-surge via the radial route. Vasc Dis Manag Blog August 2011.
Fig. 1. The important aspect of the technique is to make sure the guiding catheter is firmly intubated in the treated vessel. In this figure, the stent has been placed at the site of the lesion.
Fig. 2. A stent is deployed with simple negative suction performed simultaneously.
http://dx.doi.org/10.1016/j.carrev.2014.12.003 1553-8389/© 2014 Elsevier Inc. All rights reserved.
References
