Successful treatment of a distal saphenous vein graft lesion using the Proxis Embolic Protection System.

"No-reflow" complicates 10% to 15% of saphenous vein graft (SVG) percutaneous coronary interventions (PCIs). It is suggested by some studies to be the cause of a 31% rate of acute myocardial infarction and may increase in-hospital mortality 10-fold. A 73-year-old white male with a history of coronary artery bypass surgery, paroxysmal atrial fibrillation, hyperlipidemia, and renal insufficiency presented with progressive exertional chest pain relieved by rest. Angiography revealed a minor stenosis in the right coronary artery and the left anterior descending artery (LAD). The left internal mammary artery to the LAD was occluded, as was the native circumflex. The patient underwent primary PCI of the SVG to the posterior lateral branch with balloon predilation of the target vessel, which resulted in a "no-reflow" phenomenon. The patient then underwent intervention with the Proxis Embolic Protection System, which reduced the distal stenosis to 0% with thrombolysis in myocardial infarction 3 flow.