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

Abstract

We evaluated the acute and long-term results of percutaneous transluminal coronary angioplasty in 140 patients with prior coronary artery bypass grafting treated over a 10-year period (1981-1991). Angioplasty was technically successful in 85% of 122 nonoccluded native vessels and in 86% of 50 saphenous vein grafts. Two patients (1.4%) had a myocardial infarction and there were three procedure-related deaths (2.1%). The cumulative probability of survival was 91.5% and 74.5% at 1 and 5 years, respectively. Survival free from myocardial infarction and repeat bypass grafting at 1 and 5 years was 77.3% and 53.9%, respectively. At census, 31% of the 117 survivors were asymptomatic, and 47% were improved by at least two angina grades. Coronary angioplasty provides an apparently safe and effective alternative method of revascularization in selected patients with prior coronary artery bypass grafting. This treatment strategy potentially avoids reoperation with its attendant risks.

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

“…These early results are in accordance with those of other authors who used stent implantation to treat multivessel coronary disease, except for the incidence of non-Qwave acute myocardial infarction, which was lower in our study (1.7% in GI and 1.5% in GII) as compared with the incidence in the series of other authors, which ranged from 6% to 18% [23][24][25][26] . A probable explanation for this fact is that those authors included patients with lesions located in saphenous vein bypasses and used rotational and directional atherectomy as an adjunct device; these strategies relate to a higher rate of early complications [27][28][29][30][31][32] .…”

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

“…Ischemia occurring more than 1 year postoperatively usually reflects the development of new stenoses in graft conduits and/or native vessels that may be amenable to PCI (548). At 3 years or more after SVG implantation, atherosclerotic plaque is frequently evident and is often progressive.…”

Percutaneous Saphenous Vein Graft Interventions with and without Distal Filter Wire Protection

“…Catheter‐based saphenous vein graft (SVG) interventions with and without implantation of stents are associated with the risk of distal embolization when friable material is dislodged from the bypass during dilatation or stent expansion. This type of embolization may block microvascular perfusion in the grafted coronary artery, leading to no reflow phenomena and myocardial infarctions (MIs), reflected by elevation of myocardial enzymes following SVG interventions 1–3 . Elevation of myocardial enzymes after SVG interventions is in turn strongly related to late mortality 4 …”