For SVG graft stenting, do you consider routinely embolic protection devices (EPD), and do you factor lesion location (prox vs distal) for decision making?

I would prefer to use an embolic protection device, provided it can be easily deployed and the lesion is suitable for it. Avoid, if the lesion is a very distal graft or attachment site. In most cases, I prefer to do direct stenting of the SVG graft to avoid any embolization even with a protection de...

The upside, if feasible, outweighs the potential downside, of using DEP for SVG lesions. No reflow from downstream embolization can be catastrophic. An adequate landing zone and a wee bit longer in procedure time are the only downsides.

High-dose intra-graft Cardene obviates the need for DEP if no large thromboembolic material is visualized on the angiogram.

The ‘rare limiting step’ is frequently the landing zone.