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Approach to the Patient with Prior Bypass Surgery

Approach to the Patient with Prior Bypass Surgery General Overview Patients who experience recurrence of ischemia after coronary artery bypass graft surgery (CABG) have lesions in diverse anatomic distributions (saphenous vein graft (SVG), native arteries, internal mammary, radial, gastroepiploic graft, or proximal subclavian artery). The results of percutaneous coronary interventions (PCI) depend on the types of conduits (native artery, arterial, or saphenous vein grafts) or the locations on the conduits (proximal, mid, distal, or at the anastomotic sites) and the age of the grafts. Despite the use of new interventional devices, SVG intervention was still associated with significant in‐hospital mortality (8%) and Q‐wave myocardial infarction (MI) (2%). The clinical and technical problems encountered during PCI of SVG are listed in Table 1 . 1 Clinical and Technical Problems During PCI of SVG Problems Corrective Measures Adverse Outcomes Diffuse disease Long stent High rate of restenosis Thrombus Thrombectomy Distal embolization Degenerated SVG Distal protection Distal embolization Restenosis Drug‐eluting stent (DES) ?% restenosis Brachytherapy (VBT) Restenosis after VBT Problems without solution yet: Progression of disease in other areas of the graft. Retrograde embolization during PCI of aorto‐ostial lesions. Distal protection in bifurcation lesions: One or two devices? Which branch? Early Postoperative Ischemia (<1 month) The most common cause http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Interventional Cardiology Wiley

Approach to the Patient with Prior Bypass Surgery

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References (24)

Publisher
Wiley
Copyright
Copyright © 2004 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0896-4327
eISSN
1540-8183
DOI
10.1111/j.1540-8183.2004.04033.x
pmid
15491339
Publisher site
See Article on Publisher Site

Abstract

General Overview Patients who experience recurrence of ischemia after coronary artery bypass graft surgery (CABG) have lesions in diverse anatomic distributions (saphenous vein graft (SVG), native arteries, internal mammary, radial, gastroepiploic graft, or proximal subclavian artery). The results of percutaneous coronary interventions (PCI) depend on the types of conduits (native artery, arterial, or saphenous vein grafts) or the locations on the conduits (proximal, mid, distal, or at the anastomotic sites) and the age of the grafts. Despite the use of new interventional devices, SVG intervention was still associated with significant in‐hospital mortality (8%) and Q‐wave myocardial infarction (MI) (2%). The clinical and technical problems encountered during PCI of SVG are listed in Table 1 . 1 Clinical and Technical Problems During PCI of SVG Problems Corrective Measures Adverse Outcomes Diffuse disease Long stent High rate of restenosis Thrombus Thrombectomy Distal embolization Degenerated SVG Distal protection Distal embolization Restenosis Drug‐eluting stent (DES) ?% restenosis Brachytherapy (VBT) Restenosis after VBT Problems without solution yet: Progression of disease in other areas of the graft. Retrograde embolization during PCI of aorto‐ostial lesions. Distal protection in bifurcation lesions: One or two devices? Which branch? Early Postoperative Ischemia (<1 month) The most common cause

Journal

Journal of Interventional Cardiology – Wiley

Published: Oct 1, 2004

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