[Embolism prevention during interventional treatment of aortocoronary bypass stenoses].

No-reflow is an unpredictable complication after percutaneous intervention in saphenous vein grafts. Plaque embolism, vasoconstriction and thrombosis are mechanisms that lead to poor distal run-off. Treatments with alternative techniques like DCA, TEC and ELCA as well as phamacological attempts like GP IIb/IIIA inhibitors, vasodilators and calcium-channel blockers do not improve outcome. This is the rationale for the development of mechanical devices to prevent distal embolization. Two concepts of distal protection devices are currently realized: occlusive balloon and filtering devices. The largest experience comes from the PercuSurge GuardWire, an occlusive balloon device. The recently presented data from the SAFER trial showed a significant prevention of distal embolization and improvement in clinical outcome. The second generation of filter devices is under investigation; the advantages of these systems are the preservation of blood flow and precise angiography-guided stent positioning. Another issue of investigation is a broader use of protection devices in carotid stenting, and in interventions in acute MI and acute coronary syndromes.