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Distal embolic protection for SVG interventions: can we afford not to use it?

The development of atherosclerosis in saphenous vein grafts (SVGs) is one of the limiting factors in coronary artery bypass surgery. Approximately one half of vein conduits are significantly diseased or occluded at 10 years. A surgical revascularization strategy is often not pursued secondary to the incremental risks associated with a repeat bypass procedure. For this reason, percutaneous treatment of SVG disease is often the first option for a majority of patients. However, catheter-based treatment of SVG disease is associated with increased morbidity and mortality compared with native coronary arterial percutaneous intervention. This is often the result of distal embolization of atherothrombotic disease, leading to the phenomenon of "no-reflow." Intraprocedural pharmacological therapy has historically been the mainstay of treatment for these patients. However, more recently, the development of a mechanical embolic protection device has shown to be beneficial for the prevention of these complications. This article will review the types of embolic protection devices and the clinical studies that have proven their necessity in percutaneous SVG intervention.