The Alirocumab for Stopping Atherosclerosis Progression in Saphenous Vein Grafts (ASAP-SVG) Pilot Trial

Inclusion Criteria:

1. Age 18 years or greater.

2. Willing and able to give informed consent. The patients must be able to comply with
study procedures and follow-up.

3. Undergoing clinically-indicated coronary and SVG angiography.

4. Have at least one target saphenous vein graft with an intermediate SVG lesion (defined
as a lesion with 30-60% angiographic diameter stenosis) amenable to examination with
IVUS. The SVG should have no thrombus or ulceration and should not be considered
responsible for the patient's clinical presentation and referral for angiography.

5. Receiving optimal statin therapy defined as use of a high intensity statin
(atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily), any statin therapy with
achieved LDL-C level <70mg/dL, or maximally-tolerated statin dose for patients who are
statin intolerant statin.

Exclusion Criteria:

1. Positive pregnancy test or breast-feeding.

2. Coexisting conditions that limit life expectancy to less than 18 months or that could
affect a patient's compliance with the protocol.

3. Estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2.

4. Severe peripheral arterial disease limiting vascular access.

5. History of allergic reaction to iodine-based contrast agents that cannot be
premedicated.

6. Known hypersensitivity to alirocumab.

7. Any prior use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor
therapy.