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Treatment
Treatment of Saphenous Vein Graft Disease (Previous CABG)
COR LOE
Recommendations
2a B-R 1. In select patients with previous CABG undergoing PCI
of a SVG, the use of an embolic protection device, when
technically feasible, is reasonable to decrease the risk of distal
embolization.
2a B-NR 2. In patients with previous CABG, if PCI of a diseased native
coronary artery is feasible, then it is reasonable to choose PCI
of the native coronary artery over PCI of the severely diseased
SVG.
3: No
benefit
C-LD 3. In patients with a chronic occlusion of a SVG, percutaneous
revascularization of the SVG should NOT be performed.
Treatment of Patients With Stent Restenosis
COR LOE
Recommendations
1 A 1. In patients who develop clinical ISR for whom repeat PCI
is planned, a DES should be used to improve outcomes if
anatomic factors are appropriate and the patient is able to
comply with DAPT.
2a C-EO 2. In patients with symptomatic recurrent diffuse ISR with an
indication for revascularization, CABG can be useful over
repeat PCI to reduce recurrent events.
2b B-NR 3. In patients who develop recurrent ISR, brachytherapy may be
considered to improve symptoms.
Treatment of CTO
COR LOE
Recommendation
2b B-R 1. In patients with suitable anatomy who have refractory angina
on medical therapy, after treatment of non-CTO lesions, the
benefit of PCI of a CTO to improve symptoms is uncertain.
Hemodynamic Support for Complex PCI
COR LOE
Recommendation
2b B-R 1. In selected high-risk patients, elective insertion of an
appropriate hemodynamic support device as an adjunct to
PCI may be reasonable to prevent hemodynamic compromise
during PCI.
