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EPD During SVG PCI — EECC MCQ

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HardCoronary Artery DiseaseEPD During SVG PCIEECC

A 62-year-old man with prior CABG develops recurrent angina. Angiography shows a severe stenosis at the anastomosis of the SVG to OM1, with the body of the graft appearing diffusely diseased. What specific risk does PCI to degenerated SVGs carry?

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Correct answer: D — Distal embolisation of friable atherothrombotic debris from degenerated SVGs causing no-reflow and periprocedural MI — embolic protection devices (EPDs) should be used during SVG PCI to capture embolic material

Degenerated SVGs (typically >5 years post-CABG) contain friable, lipid-rich, soft atherosclerotic plaque that is prone to distal embolisation during PCI. This causes: (1) no-reflow phenomenon (distal microvascular obstruction); (2) periprocedural MI (troponin elevation in 15-20% of SVG PCI); (3) worse outcomes compared with native vessel PCI. Embolic protection devices (EPDs) — either distal filter devices (FilterWire, SpiderFX) or distal occlusion balloons (PercuSurge) — capture embolic debris and reduce periprocedural MI. The SAFER and FIRE trials demonstrated significant reduction in MACE with EPD use during SVG PCI. The 2024 ESC CCS Guidelines recommend EPDs for SVG PCI (Class I, LOE B). Despite EPDs, SVG PCI has higher restenosis and event rates than native vessel PCI — PCI to native vessels is preferred when technically feasible.

Reference: ESC (2024): CCS Guidelines; SAFER/FIRE Trials