From a technical perspective, successful recanalization of CTOs has steadily increased over the years because of adoption of dedicated wires, novel techniques, and increased operator experience.702 In patients who undergo successful CTO recanalization, use of DES significantly reduces the need for repeated target-vessel revascularization, compared with BMS and balloon angioplasty, without compromising 5.8.2. SVGs: Recommendations Class I 1. EPDs should be used during SVG PCI when techni- cally feasible.532 535 (Level of Evidence: B) Class III: NO BENEFIT 1. Platelet GP IIb/IIIa inhibitors are not beneficial as adjunctive therapy during SVG PCI.212,571,720,721 (Level of Evidence: B) Class III: HARM 1. PCI is not recommended for chronic SVG occlu- sions.722 724 (Level of Evidence: C) See Online Data Supplement 29 for additional data regarding SVG. Adverse cardiac event rates are doubled after SVG PCI compared with native-artery PCI.536 A distal balloon occlu- sion EPD decreased the 30-day composite outcome of death, MI, emergency CABG, or target-lesion revascularization (9.6% versus 16.5%) in the only RCT comparing embolic protection with no embolic protection.532 Subsequent nonin- feriority comparisons have demonstrated similar benefit with proximal occlusion and distal filter EPDs, with benefit limited to reduction in periprocedural MI.534,535 PCI in chronic SVG occlusion is associated with low success rates, high complication rates, and poor long-term patency rates.722,723 Restenosis and target-vessel revascularization rates are lower with DES compared with BMS, although mortality and stent thrombosis rates are similar.725 The use of covered stents is limited to the treatment of the uncommon complication of SVG perforation. Balloon angioplasty for distal SVG anastomotic stenoses has low restenosis rates,724 so stenting is commonly reserved at this location for subop- timal balloon angioplasty results or restenosis. 