Pseudo-no-reflow phenomenon in ostial saphenous vein graft intervention using FilterWire EX protection

Distal protection using FilterWire EX has been shown to be effective in reducing the incidence of debris embolization and no-reflow phenomenon in saphenous vein graft (SVG) intervention. We present a case of mechanical obstruction of antegrade flow by atherothrombotic debris collected in the FilterWire EX after stent implantation of the ostial SVG lesion, masqueraded as no-reflow phenomenon. The condition was promptly reverted by thrombosuction using an Export Aspiration Catheter. A heavy debris burden was recovered by the thrombosuction and there was no evidence of myonecrosis after the procedure. We emphasize that different distal protection device can complement each other in special situations. A brief overview of the various approaches in preventing distal embolization in SVG intervention was also given.