Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
EuroIntervention. 2011 Dec;7(8):955-61. doi: 10.4244/EIJV7I8A151.
To assess the main predictors and significance of filter no-reflow (FNR) in protected saphenous vein graft (SVG) percutaneous coronary intervention (PCI) and the effect of two different filter-based devices on FNR incidence. The phenomenon of FNR has been described as a transient impairment of blood flow due to debris plugging of a filter-based device used to shield the distal microvasculature during SVG PCI.
Fifty consecutive patients treated with SVG PCI were enrolled, using two different filter-based devices (FilterWire EZ™ [Boston Scientific, Natick, MA, USA] and SpiderRX® [Ev3, Plymouth, MN, USA]). We evaluated: 1) the value of clinical and angiographic variables for predicting FNR including the recently-described "degeneration score" (DS); 2) the predictive value of FNR for post-procedural (type IVa) myocardial infarction (MI); 3) the effect of filter type on incidence of FNR. FNR was observed in 30% of patients and was predicted by a higher DS at baseline (2.1±0.9 vs. 1.4±0.8, p=0.02, respectively) as well as by the type of filter used (54% vs. 23% in SpiderFX and FilterWire EZ, respectively, p=0.04). However, at multivariate analysis DS was the only independent predictor of FNR (OR 2.47, CI 95% 1.06-5.76, p=0.04). Graft age and FNR were found to be independent predictors of type IVa MI (OR 1.28; CI%E2%80%AF95% 1.01-1.64, p=0.04 and OR 15.69; CI%E2%80%AF95% 2.12-116.39, p=0.007, respectively).
FNR is a common complication of protected SVG stenting. FNR occurs mainly in grafts with a high degeneration score, and the presence of FNR predicts post-procedural myocardial infarction.
评估保护的隐静脉移植物（SVG）经皮冠状动脉介入治疗（PCI）中滤器无复流（FNR）的主要预测因素和意义，以及两种不同滤器装置对 FNR 发生率的影响。FNR 现象描述为在 SVG PCI 期间使用滤器装置屏蔽远端微血管时，由于碎片堵塞滤器装置而导致的血流短暂受损。
连续入组 50 例接受 SVG PCI 治疗的患者，使用两种不同的滤器装置（FilterWire EZ[波士顿科学公司，马萨诸塞州纳蒂克]和 SpiderRX[Ev3，明尼苏达州普利茅斯]）。我们评估了：1）预测 FNR 的临床和血管造影变量的价值，包括最近描述的“退化评分”（DS）；2）FNR 对术后（IVa 型）心肌梗死（MI）的预测价值；3）滤器类型对 FNR 发生率的影响。30%的患者出现 FNR，其预测因素为基线时较高的 DS（2.1±0.9 与 1.4±0.8，p=0.02）以及使用的滤器类型（SpiderFX 和 FilterWire EZ 分别为 54%和 23%，p=0.04）。然而，多变量分析显示 DS 是 FNR 的唯一独立预测因素（OR 2.47，95%CI 1.06-5.76，p=0.04）。移植物年龄和 FNR 被发现是 IVa 型 MI 的独立预测因素（OR 1.28；95%CI 1.01-1.64，p=0.04 和 OR 15.69；95%CI 2.12-116.39，p=0.007，分别）。
FNR 是保护的 SVG 支架置入术的常见并发症。FNR 主要发生在高退化评分的移植物中，FNR 的存在预测术后心肌梗死。
