Embolic Protection Devices in Saphenous Vein Graft and Native Vessel Percutaneous Intervention: A Review

Abstract

The clinical benefit of percutaneous intervention (PCI) depends on both angiographic success at the site of intervention as well as the restoration of adequate microvascular perfusion. Saphenous vein graft intervention is commonly associated with evidence of distal plaque embolization, which is correlated with worse clinical outcomes. Despite successful epicardial intervention in the acute MI patient treated with primary PCI, distal tissue perfusion may still be absent in up to 25% of cases [1-3]. Multiple devices and pharmacologic regimens have been developed and refined in an attempt to protect the microvascular circulation during both saphenous vein graft intervention and primary PCI in the acute MI setting. We will review the evidence for various techniques for embolic protection of the distal myocardium during saphenous vein graft PCI and primary PCI in the native vessel.

Educational Experience of Interventional Cardiology Fellows in the United States and Canada

“…The use of EPDs in saphenous vein graft (SVG) PCI became the standard of care largely on the basis of the SAFER (Saphenous Vein Graft Angioplasty Free of Emboli Randomized) trial, in which the PercuSurge GuardWire reduced the incidence of 30-day major adverse cardiovascular events by 42%, mainly because of a reduction in periprocedural myocardial infarction, compared with no EPD. 23 However, observational studies conducted later had conflicting results, 24 , 25 and the 2018 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines and the 2021 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines on coronary artery revascularization have a Class 2a recommendation, a downgrade from the previous Class 1 recommendation. 11 , 12 …”

Intravascular imaging and novel techniques to disrupt severely calcified lesions

“…The authors highlight that the SVG supplied a relatively large area of myocardium. Given the well-documented increase in risk of no-reflow with PCI on SVG, one could consider the concurrent use of embolic protection devices to avoid potentially jeopardising the large area of the subtended myocardium in this case [11]. As in the previous cases, we also promote the adjunct use of intracoronary imaging for procedure planning and to confirm optimal stent expansion.…”

Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting

“…57 Notably, the complexity of NV lesions will inevitably affect the success rate of PCI. 58 3.2 SVG PCI: SVG PCI is more effective than redo-CABG but is associated with the risk of intraoperative distal embolization and postoperative restenosis; the long-term effect of SVG PCI is inconclusive. Current guidelines do not recommend PCI for use in fully occluded SVGs.…”