SnackableHealth™ | PROCTOR: Native Vessel PCI Surpasses SVG Intervention in Post-CABG Patients

In this SnackableHealth™ episode recorded during TCT 2025, Dr. Ruben de Winter and Dr. C. Michael Gibson discussed the pivotal PROCTOR trial, which compared percutaneous coronary intervention (PCI) performed on native coronary arteries versus saphenous vein grafts (SVGs) in patients with a history of coronary artery bypass grafting (CABG).

Dr. de Winter explained that although SVGs have long been the traditional target for revascularization after bypass, their long-term patency remains limited. “Vein grafts degenerate over time, and PCI on these targets carries a higher risk of distal embolization and no-reflow phenomena,” he noted.

The PROCTOR trial provided compelling evidence favoring native vessel intervention, demonstrating lower rates of major adverse cardiac events (MACE), fewer periprocedural complications, and more durable outcomes compared with PCI on vein grafts. Notably, procedural success was higher and embolic protection less frequently required when targeting the native coronary circulation.

Dr. Gibson emphasized the practical implications for interventional cardiologists: “Whenever technically feasible, native vessel PCI should be the preferred strategy in post-CABG patients. These findings challenge the long-standing tendency to approach the graft first.”

Both experts agreed that evolving techniques and modern devices have improved the feasibility of native vessel revascularization, further reinforcing a shift toward a “native-first” approach in this complex population.