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Determinants of embolic protection device use: Case study in the acceptance of a new medical technology

As innovative technologies emerge and clinical trial evidence demonstrates their efficacy, incorporating the use of new devices into routine clinical practice becomes a challenge. Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) has remained a problematic subset in modern day practice, as it may be complicated by distal embolization and the no-reflow phenomenon [1]. As a consequence, periprocedural myocardial infarction and major adverse cardiovascular events (MACE) are more frequent when PCI is attempted in SVGs [2–3]. Adjunctive platelet glycoprotein IIb/ IIIa inhibitor usage has had no effect on MACE rates in SVG PCI [4]. The development of distal protection devices for use in this setting holds the promise of improved results. Approved devices consist of balloon occlusion aspiration systems and mechanical filters to be placed within the vein graft during the intervention. Randomized studies demonstrating the capability of these devices to decrease MACE have been conducted [5–7]. Given the evidence supporting usage of distal protection devices for SVG PCI, a survey of SCAI members was developed to analyze the determinants of its use and to define the current frequency of its employment by interventionists in the United States. MATERIALS AND METHODS