Preventing Distal Embolization of Coils After Therapeutic Graft Closure: The CRISP Technique.

Patients with coronary artery bypass surgery will invariably experience graft failure. In this setting, treatment of the native vessel is recommended. After successful native vessel intervention, competitive flow from a patent graft may limit the durability of native vessel intervention, and thus therapeutic graft closure is usually recommended. Graft closure is frequently achieved with coils, but a recognized complication with coils is distal embolization during or after deployment. The presence of disease or tortuosity in grafts may allow stable deployment of coils and prevent this. However, with relatively patent grafts, it may be difficult to deploy coils without a risk of embolization. To overcome this problem, we propose a new technique where we strategically deploy and fashion a partially crushed stent in the body of the graft to serve as a plug to hold coils and prevent distal embolization, called the CRISP (CRushed In situ Stent Plug) technique.