Embolic Protection Device for Saphenous Vein Graft Intervention

Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) is considered a high-risk procedure because of the degeneration of the graft, which is associated with a high rate of distal embolization and no-reflow phenomenon. This results in an increased rate of periprocedural myocardial infarction and death.1 As a result, PCI of the native artery is preferred for SVG intervention.2 Prevalence of PCI of a failed SVG is ≈6% of all PCI procedures. SVGs, nevertheless, are still frequently used in bypass surgeries, and given their high failure rate, which averages ≈50% to 60% at 10-year follow-up,3 we are destined to encounter them in future coronary interventions.4See Article by Brennan et al Embolic protection devices (EPDs) were introduced to mitigate the distal embolization rate and prevent the no-reflow phenomenon during PCI of the SVG. The US Food and Drug Administration—approved EPD are categorized by mechanism of action: an occlusion balloon followed by aspiration with or without rinsing, or with a filter-based design to capture the plaque debris during the intervention.The efficacy and use of balloon occluder with aspiration devices (GuardWire) were first studied in the Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) trial.5 SAFER was the only randomized trial powered to test the effectiveness of PCI with EPD against PCI alone. The trial demonstrated a reduction in 30-day major adverse cardiac events in the GuardWire-treated patients versus control (9.6% versus 16.5%; P =0.004), mainly driven by reduction in periprocedural myocardial infarction and no-reflow. On the basis of these results, the American College of Cardiology guidelines granted a class I recommendation for EPD use in PCI of failed SVG.6 These guidelines have led to a myriad of devices, including different filters, proximal occluders, a combination of rinse …