Journal of Invasive Cardiology

Discussion. The treatment of complex saphenous vein graft disease with percutaneous intervention has allowed patients to undergo successful treatment without repeat surgery. The challenges associated with this treatment involve preventing the complications that can occur in severely diseased SVGs. Distal emboli causing no-reflow with subsequent infarction and poor clinical outcome have resulted in the development of devices to trap emboli and protect the distal circulation during complex interventions of SVGs. Since distal protection was first described in SVGs,^2,3 devices have been developed for the treatment of carotid arteries.^4,5 The initial devices were balloon occlusive devices over an angioplasty wire preventing distal embolization of debris and removal of embolic debris through a suction catheter. The development of expandable filter nets over an angioplasty wire have allowed distal protection without occlusion.
We used the FilterWireEX to protect the LAD (despite the current recommendations for use in SVG interventions only, we were concerned that distal emboli could result in LAD compromise). To adequately protect the 6.0 mm distal SVG and obtain complete coaptation of the vessel wall by a filter to trap potential emboli, we used the larger AccuNet device designed for carotid stenting. Since the SVG was 6.0 mm, a 0.35 inch compatible peripheral stent allowed for advancement over both wires and safe deployment of the stent in a severely diseased segment of the SVG. The presence of atherosclerotic debris in both filter devices strongly suggests that the possibility of no-reflow was prevented by using this technique.
We feel that this procedure is a great example of the use of both peripheral and coronary techniques to safely and effectively treat a severe stenosis in a large SVG.