Percutaneous transluminal angioplasty of stenosed aortocoronary bypass grafts.

Abstract

SUMMARY During the period between October 1980 and December 1982, percutaneous transluminal angioplasty of stenosed aortocoronary bypass grafts was attempted 44 times in 31 patients who had developed disabling angina pectoris four months to seven years after coronary bypass surgery. The primary success rate was 93%. Two (4-5%) patients developed myocardial infarction related to the procedure. No emergency aortocoronary bypass surgery was required and there was no mortality. Although the primary success rate was high, the incidence of recurrence after one or more angioplasties was 50%/o. Despite this recurrence rate the condition of 10 of the first 16 (62%) patients was clinically improved after a mean follow up of 26 months.Recurrence of angina in patients after aortocoronary bypass graft surgery is related to graft occlusion or stenosis or to progression of coronary artery disease. The management of such patients has been either conservative or by repeat cardiac surgery. Percutaneous transluminal angioplasty has been used as an alternative to repeat cardiac surgery for stenoses in the native coronary arteries as well as in the bypass grafts. This report deals exclusively with our experience of percutaneous transluminal angioplasty of stenosed bypass grafts. Patients and methodsBetween October 1980 and December 1982 we attempted percutaneous transluminal angioplasty of stenosed aortocoronary bypass grafts 44 times in 31 patients. These patients had developed disabling angina pectoris four months to seven years after coronary bypass surgery. The procedure was attempted in 26 left anterior descending grafts, 13 right coronary artery grafts, and five circumflex artery grafts. Angioplasty was performed using the technique described by Gruntzig et al. I A preformed guiding catheter (8 or 9F, Schneider Medintag or USCI) was used to insert the grafts. The following types (Fig. 1)

Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting: ten years' experience

“…Other studies of saphenous vein graft angioplasty have reported angiographic success rates of 75 -97% [ 10, I 1 , [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] (Table V), consistent with the 86% in our study. The highest success rate was seen with stenoses located at the distal anastomotic site (96%), followed by stenoses located in the graft body (90%) and proximal anastomotic site (50%).…”

Retrograde coronary angioplasty of isolated arterial segments through saphenous vein bypass grafts

“…This has resulted from the attrition of grafts and return of angina over time characteristic of patients with prior CABS [l-31, and the recognized higher mortality and less successful results of re-operation [6-113. In conjunction with previous reports demonstrating the utility of PTCA in patients with prior CABS [12][13][14][15][16], this report emphasizes an additional means of achieving more complete revascularization with PTCA technology. Although technically challenging, retrograde dilatation through vein grafts has been facilitated by improvements in catheter and wire technology and can play an important role in effective angioplasty strategies.…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…Before the general availability of coronary stenting, overall angioplasty procedural success rates exceeded 90%, and adverse outcomes of emergency repeat coronary bypass surgery (2.3%) and death (0.8%) were infrequent as reported in combined series of over 2000 patients with prior bypass surgery undergoing percutaneous intervention (250,(585)(586)(587)(588)(589)(590)(591)(592)(593)(594)(595)(596)(597). These results are comparable to those achieved in patients without prior bypass surgery, an observation confirmed by NHLBI registry data (7).…”