Sealing Intermediate Nonobstructive Coronary Saphenous Vein Graft Lesions With Drug-Eluting Stents as a New Approach to Reducing Cardiac Events

Rodés‐Cabau, Josep; Jolly, Sanjit S.; Cairns, John A.; Mansour, Samer; L’Allier, Philippe L.; Teefy, Patrick; Graham, John; May, Michel R. Le; Cantor, Warren J.; Wood, David; Balasubramanian, Kumar; DeLarochellière, Robert; Dzavik, Vlad

doi:10.1161/circinterventions.116.004336

Cited by 18 publications

(5 citation statements)

References 29 publications

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“…The ITA, an endothelialized conduit, demonstrates excellent longterm patency due to its resistance to atherosclerosis. The use of radial artery grafts, once considered challenging, has become more prevalent due to refinements in surgical technique and patient selection criteria [31][32][33]. Advancements in graft selection in CABG have revolutionized the field of cardiac surgery, enhancing patient outcomes and redefining surgical strategies.…”

Section: Advancements In Graft Selectionmentioning

confidence: 99%

Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review

Thakare,

Sontakke,

Wasnik

et al. 2023

Cureus

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Coronary artery bypass grafting (CABG) has witnessed remarkable progress in recent years, driven by innovative techniques and refined approaches that have transformed patient outcomes and treatment paradigms. This review article comprehensively explores the latest advances in CABG techniques and their consequential impacts on patient outcomes. The advent of minimally invasive CABG techniques has revolutionized traditional surgical approaches. Robotic-assisted surgery and small thoracotomy methods offer reduced invasiveness, yielding shorter recovery times and improved patient satisfaction. Integrating CABG with percutaneous coronary intervention (PCI), hybrid procedures have emerged as a versatile strategy, providing tailored treatment solutions for complex coronary anatomies. The paradigm shift to off-pump CABG, which preserves the beating heart during surgery, has shown promise in reducing perioperative complications and neurocognitive deficits. Advances in graft selection, particularly the utilization of arterial grafts such as the internal thoracic artery and radial artery, have significantly enhanced graft patency rates and long-term survival. Adjunctive technologies, such as intraoperative imaging and graft flow assessment, have bolstered the precision of CABG procedures. Pharmacological agents have demonstrated their potential to improve graft outcomes. Surgical decision-making is now optimized based on patient characteristics and disease severity owing to the development of patient selection and risk stratification tools. Long-term results have also significantly improved. Patients undergoing CABG have higher survival rates, less angina, and better quality of life. Developing more resilient grafts through tissue engineering, using bioresorbable materials in graft fabrication, and using gene therapy to improve graft patency and overall cardiac recovery are all exciting future research directions. This review's summary of current developments in CABG procedures highlights their profoundly positive effects on patient outcomes. These developments can change the face of cardiovascular care by giving clinicians more tools to treat coronary artery disease (CAD) and enhance patients' quality of life.

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Section: Advancements In Graft Selectionmentioning

confidence: 99%

Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review

Thakare,

Sontakke,

Wasnik

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…The results were attributed to late (>2 year) restenosis after SVG stenting that resulted in loss of the early beneficial effect of stenting. 70 Patients with intermediate SVG lesions are currently treated medically with control of diabetes, smoking cessation, and aggressive lipid lowering. Although mean low-density lipoprotein level was <70 mg/dL in VELETI II, SVG failure rates were high, suggesting that even more strict lipid control may be necessary.…”

Section: Treatment Of Intermediate Svg Lesionsmentioning

confidence: 99%

“…The results were attributed to late (>2 year) restenosis after SVG stenting that resulted in loss of the early beneficial effect of stenting. 70…”

Section: Treatment Of Intermediate Svg Lesionsmentioning

confidence: 99%

Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies

et al. 2021

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Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%–60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible.

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“…Degenerated SVG lesions tend to be more lipid-rich with poorly developed or even absent fibrous cap compared to native coronary vessel lesions. Interestingly, it has been suggested that sealing even mild or moderate SVG lesions with DES does not necessarily reduce the incidence of long-term MACE compared to medical treatment alone [ 46 , 47 ]. The deployment of stents in SVGs may well lead to a more enhanced inflammatory and thrombotic reaction, which may be difficult to reverse in the acute phase.…”

Section: Stent Choice In Svg Lesionsmentioning

confidence: 99%

Percutaneous Coronary Intervention of Native Artery Versus Bypass Graft in Patients with Prior Coronary Artery Bypass Graft Surgery

Farag¹,

Brilakis²,

Gasparini³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Percutaneous coronary intervention (PCI) is common in patients with prior coronary artery bypass graft surgery (CABG), however, there is limited data on the association between the PCI target-vessel and clinical outcomes. In this article, we provide a state-of-the-art overview of the contemporary management of patients with prior CABG and a clear indication for revascularization. Methods: We performed a structured literature search of PubMed and Cochrane Library databases from inception to March 2021. Relevant studies were extracted and synthesized for narrative review. Results: Twenty-six observational studies focusing on PCI of bypass graft versus native coronary artery lesions in 366,060 patients with prior CABG were included. The data from observational studies suggest that bypass graft PCI is associated with higher short-and long-term major adverse cardiac events compared to native coronary artery PCI. Conclusions: Whenever feasible, native coronary artery PCI should be the prioritized treatment for saphenous vein graft failure. Prospective randomized trials are needed to elucidate the optimal revascularization strategy for patients with prior CABG.

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Sealing Intermediate Nonobstructive Coronary Saphenous Vein Graft Lesions With Drug-Eluting Stents as a New Approach to Reducing Cardiac Events

Cited by 18 publications

References 29 publications

Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review

Recent Advances in Coronary Artery Bypass Grafting Techniques and Outcomes: A Narrative Review

Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies

Percutaneous Coronary Intervention of Native Artery Versus Bypass Graft in Patients with Prior Coronary Artery Bypass Graft Surgery

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