Rheolytic thrombectomy with distal filter embolic protection as adjunctive therapies to high-risk saphenous vein graft intervention.

Percutaneous intervention of saphenous vein graft (SVG), especially those with heavy atherothrombotic load, presents high risk for distal embolization and no-reflow. Using the distal filters alone may occasionally be disadvantageous because of the large debris burden and the inability to assess the underlying culprit lesions and vessel size accurately. We present a case of intervention of an occluded SVG using a combination of rheolytic thrombectomy and distal filter embolic protection as a pretreatment before stenting. This strategy has the potential to reduce further the risk of no-reflow and to provide visualization for proper assessment of the underlying anatomy especially in clot-laden vessels.