An update on coronary bypass graft intervention

Abstract

Coronary artery bypass grafting (CABG) remains one of the most common surgical procedures. In spite of great advancements like arterial grafts and off-pump bypass procedure, recurrent ischaemia may ensue with the lesions of the graft. Early postoperative ischaemia (<30 days) is due to graft occlusion or stenosis, and percutaneous coronary intervention (PCI) is frequently feasible. Late postoperative ischaemia (>3 years) is most often due to a saphenous vein graft (SVG) lesion. Multiple diseased grafts, reduced left ventricular function, and available arterial conduits favour repeat CABG, whereas, a patent left internal mammary artery to left anterior descending favours PCI. Embolic protection reduces atheroembolic myocardial infarction during PCI of SVG and should be routinely used in treatment of SVG lesions. A variety of vasodilators may reduce the risk of or mitigate the consequences of noreflow. Drug-eluting stents reduce restenosis in SVG grafts, and have become the default strategy for many interventionalists.

Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions

“…Unfortunately, no reflow is still seen despite the use of protection devices which could be the result of emboli during primary crossing, incomplete capture or during device retrieval due to injury at deployment site, small particles, or filter overload. 31 GP2b/3a inhibitors: The EPIC trial 32 first favored the use of abciximab therapy during percutaneous treatment of SVG lesions. However, a pooled analysis of five randomized trials of intravenous GP2b/3a inhibitor in SVG proved no benefit in terms of individual or combined end points either at 30 days or at 6 months.…”