Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease

Liu, Lin; Liu, Wenjie; Wang, Xi; Pan, Liang; Wang, Xule; Zheng, Xiaolin; Li, Ran; Shan, Yingguang; Peng, Meng; Qiu, Chunguang

doi:10.3389/fcvm.2023.982880

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…Degenerated or chronically-occluded SVG conduits can be used by experienced operators to perform retrograde recanalisation of the native coronary, however, with good procedural success rates [74] (Figure 2). While the feasibility of drug-eluting balloons (DEB) for de-novo graft lesions has been described in several small case series, their results have been variable and as such, require further evaluation before being adopted in wider practice [75,76].…”

Section: Percutaneous Coronary Intervention To a Failing Saphenous Ve...mentioning

confidence: 99%

“…Degenerated or chronica occluded SVG conduits can be used by experienced operators to perform retrograde canalisation of the native coronary, however, with good procedural success rates [74] (F ure 2). While the feasibility of drug-eluting balloons (DEB) for de-novo graft lesions been described in several small case series, their results have been variable and as su require further evaluation before being adopted in wider practice [75,76]. sented acutely to our facility with an inferior ST-segment elevation myocardial infarction (STEM He was transferred for emergency coronary angiography where his culprit lesion was identifie his SVG to RCA which had occluded proximal to his previous drug-eluting stent (DES).…”

Section: Percutaneous Coronary Intervention To a Failing Saphenous Ve...mentioning

confidence: 99%

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Saphenous Vein Graft Failure: Current Challenges and a Review of the Contemporary Percutaneous Options for Management

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Ladwiniec

2023

JCM

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The use of saphenous vein grafts (SVGs) in the surgical management of obstructive coronary artery disease remains high despite a growing understanding of their limitations in longevity. In contemporary practice, approximately 95% of patients receive one SVG in addition to a left internal mammary artery (LIMA) graft. The precise patency rates for SVGs vary widely in the literature, with estimates of up to 61% failure rate at greater than 10 years of follow-up. SVGs are known to progressively degenerate over time and, even if they remain patent, demonstrate marked accelerated atherosclerosis. Multiple studies have demonstrated a marked acceleration of atherosclerosis in bypassed native coronary arteries compared to non-bypassed arteries, which predisposes to a high number of native chronic total occlusions (CTOs) and subsequent procedural challenges when managing graft failure. Patients with failing SVGs frequently require revascularisation to previously grafted territories, with estimates of 13% of CABG patients requiring an additional revascularisation procedure within 10 years. Redo CABG confers a significantly higher risk of in-hospital mortality and, as such, percutaneous coronary intervention (PCI) has become the favoured strategy for revascularisation in SVG failure. Percutaneous treatment of a degenerative SVG provides unique challenges secondary to a tendency for frequent superimposed thrombi on critical graft stenoses, friable lesions with marked potential for distal embolization and subsequent no-reflow phenomena, and high rates of peri-procedural myocardial infarction (MI). Furthermore, the rates of restenosis within SVG stents are disproportionately higher than native vessel PCI despite the advances in drug-eluting stent (DES) technology. The alternative to SVG PCI in failed grafts is PCI to the native vessel, ‘replacing’ the grafts and restoring patency within the previously grafted coronary artery, with or without occluding the donor graft. This strategy has additional challenges to de novo coronary artery PCI, however, due to the high burden of complex atherosclerotic lesion morphology, extensive coronary calcification, and the high incidence of CTO. Large patient cohort studies have reported worse short- and long-term outcomes with SVG PCI compared to native vessel PCI. The PROCTOR trial is a large and randomised control trial aimed at assessing the superiority of native vessel PCI versus vein graft PCI in patients with prior CABG awaiting results. This review article will explore the complexities of SVG failure and assess the contemporary evidence in guiding optimum percutaneous interventional strategy.

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Section: Percutaneous Coronary Intervention To a Failing Saphenous Ve...mentioning

confidence: 99%

Section: Percutaneous Coronary Intervention To a Failing Saphenous Ve...mentioning

confidence: 99%

Saphenous Vein Graft Failure: Current Challenges and a Review of the Contemporary Percutaneous Options for Management

Back,

Ladwiniec

2023

JCM

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“…In case of any ISR, the current guidelines recommend new generation DES and/or drug eluting balloons [9]. Whereas most available data apply to native arteries, no large high-quality data concerning the optimal management of ISR in SVG exist.…”

Section: Introductionmentioning

confidence: 99%

Late In-Stent Restenosis of a Saphenous Vein Graft Treated with High Pressure Balloon Dilatation and Drug Eluting Balloon Dilatation: Case Report.

Rogowski,

Kara

2023

Preprint

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Introduction In the modern interventional treatment of degenerated saphenous vein grafts, the use of both bare metal and drug eluting stents have been described so far. Drug eluting balloons have been increasingly used in cases of in-stent restenosis and to some extent denovo stenosis of native coronary vessels. Based on pure logic approach, the use of drug eluting balloons in in-stent restenosis of the saphenous vein graft may be of great interest. Still, few high-quality data on this subject exist and no general recommendations can be made.Case presentation This paper illustrates a typical case of a symptomatic late in-stent restenosis of a saphenous vein graft occurred 15 months after a percutaneous coronary intervention with implantation of two drug eluting stents. Intravascular ultrasound revealed a mixture of stent underexpansion and severe neointima. This was treated safely with a prolonged high pressure balloon dilatation followed by dilatation with a drug eluting balloon. The primary result was very good. During the intervention the patient remained asymptomatic and was discharged the next day on dual anti-platelet therapy. During the 10-month follow-up the patient remained asymptomatic.Conclusion This case demonstrates the usefulness and clinical safety of drug eluting balloons in treating in-stent restenosis in the saphenous vein grafts.

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Late In-Stent Restenosis of a Saphenous Vein Graft Treated with High-Pressure Balloon Dilatation and Drug Eluting Balloon Dilatation: Case Report

Rogowski,

Kara

2024

SN Compr. Clin. Med.

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In the modern interventional treatment of degenerated saphenous vein grafts, the use of both bare metal and drug eluting stents have been described so far. Drug eluting balloons have been increasingly used in cases of in-stent restenosis and to some extent de novo stenosis of native coronary vessels. Based on pure logic approach, the use of drug eluting balloons in in-stent restenosis of the saphenous vein graft may be of great interest. Still, few high-quality data on this subject exist and no general recommendations can be made. This paper illustrates a typical case of a symptomatic late in-stent restenosis of a saphenous vein graft occurred 15 months after a percutaneous coronary intervention with implantation of two drug eluting stents. Intravascular ultrasound revealed a mixture of stent underexpansion and severe neointima. This was treated safely with a prolonged high pressure balloon dilatation followed by dilatation with a drug eluting balloon. The primary result was very good. During the intervention the patient remained asymptomatic and was discharged the next day on dual anti-platelet therapy. During the 10-month follow-up the patient remained asymptomatic. This case demonstrates the usefulness and clinical safety of drug eluting balloons in treating in-stent restenosis in the saphenous vein grafts.

show abstract

Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease

Cited by 3 publications

References 37 publications

Saphenous Vein Graft Failure: Current Challenges and a Review of the Contemporary Percutaneous Options for Management

Saphenous Vein Graft Failure: Current Challenges and a Review of the Contemporary Percutaneous Options for Management

Late In-Stent Restenosis of a Saphenous Vein Graft Treated with High Pressure Balloon Dilatation and Drug Eluting Balloon Dilatation: Case Report.

Late In-Stent Restenosis of a Saphenous Vein Graft Treated with High-Pressure Balloon Dilatation and Drug Eluting Balloon Dilatation: Case Report

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