Primary percutaneous coronary intervention in saphenous vein grafts: a visualization strategy to improve outcome with new uses for the aspiration catheter.

Primary percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is often a high-risk procedure associated with poor short- and long-term outcomes. Venous grafts frequently supply a clinically important myocardial territory. These vessels, however, combine the problems of a less predictable course and run-off as compared to native vessels with the presence of severe degenerative atherosclerosis. These factors amplify the risk due to an increased chance of distal embolization and no-reflow. We present three different situations during primary PCI in SVGs where a thrombosuction catheter was utilized to visualize the problem and then apply therapeutic maneuvers that proved crucial in achieving a successful result.