Larry Dean：威斯康辛地区医学中心主任，华盛顿大学医学中心内科和外科教授。目前的研究领域为隐静脉旁路移植术保护、支架和支架内狭窄。
　　International Circulation: Embolic protection devices are class I recommendations for Percuntaenous Coronary Intervention with a Saphenous Vein Graft， yet they are a still rarely used. Why is this?
　　Dr. Dean: They are likely not to be used as much as in practice because the guideline states that they should be used in a Class I recommendation “where is technically feasible.” There are some limits to the current devices in that they require a certain distance between the lesion and filter. If you have a lesion that is close to a vessel or an anastomosis that will not accept the filter， then you cannot place the device. The filters are primarily used in saphenous vein bypass grafts (SVG)， and degenerated ones in particular. The older the vein grafts are， the more likely embolic episodes are to occur， which warrant the use of the device. Technical issues can prevent you from placing the device in an appropriate position. The other thing is that while they are reasonable user-friendly， they can still be challenging. When a physician is accustomed to using standard， easy-to-place technology， balloons， and guide wires， embolic protection devices are a little more difficult to use. If it proves to be too difficult， the interventionalists will abandon the procedure.
　　《国际循环》：静脉桥血管行PCI时应用血栓保护装置是I类推荐，但目前还是非常少，请问原因是什么？
　　Dean教授：静脉桥血管行PCI时血栓保护装置在临床实践中使用不多。虽然指南为 I类推荐，但是指在“技术上可行”的医疗机构。同时，当前的设备有一些局限性，因为病变和滤网之间需有一定的距离。如果病变接近血管或吻合处不适合放置滤网，那就不能放置血栓保护装置。滤网主要是用于静脉桥血管（SVG），尤其是时间很长的SVG。SVG时间越长，越可能发生血栓事件，越需要应用血栓保护装置。技术上的问题使得我们无法将血栓保护装置放在合适的位置上。另外，尽管血栓保护装置已相当好，但仍有一定的挑战性。当医生习惯于应用标准的、容易放置的技术后，如球囊和导丝等，血栓保护装置使用上稍有困难。如果应用上太复杂，介入医生会放弃使用血栓保护装置。