A novel filter-based distal embolic protection device for percutaneous intervention of saphenous vein graft lesions: results of the AMEthyst randomized controlled trial

JACC Cardiovasc Interv. 2008 Jun;1(3):248-57. doi: 10.1016/j.jcin.2008.03.009.

Abstract

Objectives: We sought to evaluate the relative safety and efficacy of the novel Interceptor PLUS Coronary Filter System (Medtronic Vascular, Santa Rosa, California) compared with approved embolic-protection devices (e.g., GuardWire, Medtronic Vascular/FilterWire EZ, Boston Scientific, Natick, Massachusetts) during percutaneous coronary intervention (PCI) of degenerative saphenous vein grafts (SVG).

Background: Percutaneous coronary intervention of degenerative SVG is associated with embolization of atherothrombotic debris and subsequent myocardial infarction in a significant portion of patients. The use of distal embolic-protection devices has previously been demonstrated to reduce major adverse cardiovascular events associated with PCI in these patients.

Methods: In this multicenter, randomized noninferiority trial, 797 patients undergoing PCI with stenting of SVG stenoses (de novo or restenotic) with reference vessel diameter 2.5 mm to 5.25 mm were randomly assigned 2:1 to either the Interceptor PLUS (n = 533) or control distal-protection devices (GuardWire [n = 191], FilterWire EZ [n = 73]) at the physician's discretion.

Results: The trial primary clinical end point (composite occurrence of death, myocardial infarction, or urgent repeat revascularization through 30 days) was observed in 8% and 7.3% of Interceptor and control-treated patients, respectively (p = 0.025 for noninferiority; p = 0.77 for difference). Key secondary end points for device and procedural success were similar between randomly assigned treatment strategies.

Conclusions: The Interceptor PLUS Coronary Filter System is noninferior in safety and efficacy to 30 days when compared with the GuardWire and FilterWire EZ distal embolic protection devices.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Angioplasty, Balloon, Coronary / instrumentation
  • Angioplasty, Balloon, Coronary / mortality
  • Constriction, Pathologic
  • Coronary Artery Bypass / adverse effects*
  • Coronary Artery Bypass / mortality
  • Embolism / etiology
  • Embolism / mortality
  • Embolism / prevention & control*
  • Equipment Design
  • Equipment Safety
  • Female
  • Filtration / instrumentation*
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / mortality
  • Graft Occlusion, Vascular / therapy*
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Myocardial Infarction / prevention & control*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Saphenous Vein / transplantation*
  • Stents
  • Time Factors
  • Treatment Outcome
  • United States

Substances

  • Platelet Aggregation Inhibitors