<International Circulation>: What’s your opinion on thrombotic protection devices to prevent embolization during the intervention of SVGs lesions?

  《国际循环》：您对SVG介入治疗中远端保护装置有何看法？

    Prof Douglas:  Embolic protection should be used in most SVG PCIs. Exceptions are SVGs which have been in place for <3 years (narrowing in these cases is not due to atherosclerosis but is related to another process called intimal hyperplasia)， restenotic lesions (also， due to intimal hyperplasia)， or very focal stenoses where plaque volume is estimated to be small (but even in these cases randomized studies have shown benefit - the SAFER trial for example).

    Douglas教授: SVG介入治疗手术绝大多数需要血栓保护装置，除非SVG旁路移植时间小于3年（这些病变多于内膜增生有关，而并非动脉硬化），再狭窄病变（内膜增生引起的）或斑块体积较小的病变。以上特例不需血栓远端保护，但类似SAFER等随机临床试验提示用了血栓保护装置仍然是有益处的。

    <International Circulation>:  Which is the ideal type of stent to treat saphenous vein graft stenosis - the drug-eluting stents or bare-metal stents? Why?

   《国际循环》：SVG狭窄PCI治疗的最佳选择是药物洗脱支架还是裸支架？为什么？

    Prof Douglas:  I wrote an editorial about BMS vs. DES in SVGs in JACC Intervention about a year ago. Basically， there are no large randomized trials with long term follow-up. The small randomized trials， observational studies and meta-analyses (now about 10 published in the past 2-3 years) suggest that DES are safe (no increased stent thrombosis) and reduce restenosis， there is less benefit than in native vessels (i.e. arteries). In some studies there does not seem to be much benefit of DES compared with BMS when the SVG diameter is large (>3.5 mm). Also， there is not much data as to whether the reduced restenosis seen with DES persists long term (> 2 years). Consequently， some operators use DES sparingly in SVGs.

    Douglas教授: 我去年在JACC介入中写过一篇药物洗脱支架（DES）和裸支架（BMS）在SVG 介入治疗中比较的社论。总的来说，这方面目前没有大规模随机研究，小规模随机试验，临床观察和meta分析（过去2-3年有10篇）提示DES较为安全（不增加支架内血栓风险）并减少再狭窄率，但DES在SVG中的优势没有在原有血管中好，特别是动脉。一些研究表明SVG血管直径>3.5mm时DES的优势较BMS就显得不明显了。另外没有数据显示DES可长期（> 2年）降低再狭窄率，因此一些术者会慎重选择DES。

    <International Circulation>:  There is no surrogate for clinical assessment and judgment， but what role do risk stratification and prognostic models play in the management of your patients today?

  《国际循环》：目前这方面临床没有客观的评判工具，您认为危险分层和判断预后的工具对患者有什么意义？

    Prof Douglas: We try to balance risks and benefits with all clinical decisions. With respect to treatment of SVG stenoses， there is a lot written but few randomized trials and no large ones to guide our decisions regarding stenting SVG lesions.
    Douglas教授: 任何临床决策都需要权衡利弊，在SVG狭窄的介入治疗方面，文献很多但随机对照试验特别是指导临床决策的大规模试验很少。

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