Percutaneous saphenous vein graft intervention with sequential embolic protection devices: Complementing lesion anatomy with embolic protection device

Abstract

Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) carries unique technical challenges requiring the utilization of embolic protection devices (EPDs) to reduce the adverse events associated with distal embolization. Distal embolization is a common and almost ubiquitous consequence of SVG PCI due to the soft and friable nature of the SVG lesions. We describe a case of revascularizing a SVG with tandem stenoses employing the use of two different EPDs that complemented their respective lesion's location within the SVG.

Contemporary approaches to saphenous vein graft interventions: A survey of 275 interventional cardiologists

“…Selection of an EPD is based primarily on SVG lesion location: SVG body lesions can be protected using any of the commercially available EPDs, ostial lesions can only be protected using a filter‐based device, and distal anastomotic lesions can only be protected using a proximal occlusion device [8]. Therefore, availability of at least a filter‐based EPD and proximal protection is needed to protect SVG lesions at all locations [20]. Familiarity with an EPD was the second most important consideration: considering that each device requires unique handling and that most interventionalists perform a relatively low number of SVG interventions per year, consistent use of a limited number of EPDs is important to optimize technical expertise and to minimize the risk for complications [21, 22].…”

Early and midterm major adverse cardiac events in patient with saphenous vein graft using direct stenting or embolic protection device stenting

“…Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) carries unique technical challenges, requires the use of the embolic protection device (EPD) to reduce the adverse events associated with distal embolization. Distal embolization is a common and almost omnipresent consequence of SVG PCI due to the soft and friable nature of SVG lesions ( 1 ). Adequate myocardial reperfusion, and therefore acceptable functional recovery may not be achieved with traditional PCI which could be due to ischemia or the distal embolization of plaque or thrombus material from the target lesion ( 2 ).…”