Saphenous vein graft intervention.

Abstract

Saphenous vein grafts are commonly used conduits for surgical revascularization of coronary arteries but are associated with poor long-term patency rates. Percutaneous revascularization of saphenous vein grafts is associated with worse clinical outcomes including higher rates of in-stent restenosis, target vessel revascularization, myocardial infarction, and death compared with percutaneous coronary intervention of native coronary arteries. Use of embolic protection devices is a Class I indication according to the American College of Cardiology/American Heart Association guidelines to decrease the risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Nonetheless, these devices are underused in clinical practice. Various pharmacological agents are available that may also reduce the risk of or mitigate the consequences of no-reflow. Covered stents do not decrease the rates of periprocedural myocardial infarction and restenosis. Most available evidence supports treatment with drug-eluting stents in this high-risk lesion subset to reduce angiographic and clinical restenosis, although large, randomized trials comparing drug-eluting stents and bare-metal stents are needed.

• Authors: Michael S Lee, Seung-Jung Park, David E Kandzari, Ajay J Kirtane, William F Fearon, Emmanouil S Brilakis, Paul Vermeersch, Young-Hak Kim, Ron Waksman, Julinda Mehilli, Laura Mauri, Gregg W Stone
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 4 Issue 8 Pg. 831-43 (Aug 2011) ISSN: 1876-7605 [Electronic] United States
• PMID: 21851895 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antithrombins
• Platelet Aggregation Inhibitors

Topics

• Angioplasty, Balloon, Coronary (adverse effects, instrumentation)
• Antithrombins (therapeutic use)
• Coronary Artery Bypass (adverse effects)
• Coronary Artery Disease (surgery)
• Coronary Restenosis (etiology, physiopathology, therapy)
• Embolic Protection Devices
• Graft Occlusion, Vascular (etiology, physiopathology, therapy)
• Humans
• Platelet Aggregation Inhibitors (therapeutic use)
• Practice Guidelines as Topic
• Risk Assessment
• Risk Factors
• Saphenous Vein (physiopathology, transplantation)
• Stents
• Treatment Outcome
• Vascular Patency