Stent placement in saphenous vein coronary bypass grafts: its role in the prevention of restenosis.
The relentless attrition of aortocoronary vein bypass grafts often means a repeat revascularisation procedure is necessary for relief of ischaemia. Repeat coronary artery bypass revascularisation, however, is often associated with a higher mortality and morbidity, is technically more demanding and often yields inferior long-term clinical improvement compared to the initial operation. Balloon angioplasty for vein grafts is an established alternative revascularisation procedure but is hampered by an unacceptable restenosis rate, particularly for proximal and mid-graft lesions. Furthermore, it carries a significant risk of acute complication when applied to degenerated vein grafts. In contrast, there is considerable observational data documenting a lower risk of distal embolisation, a more favourable, smoother and wider lumen, and a lower risk of restenosis following stent implantation as compared to balloon angioplasty. These encouraging results must, however, await confirmation from prospective randomised trials comparing the 2 treatment strategies in a vein graft setting. This review article focuses on the promising potentials of intracoronary stenting and provides an update of its role in reducing restenosis in a vein graft setting.
Lau
K W
KW
Department of Cardiology, Singapore General Hospital.
D000800:Angioplasty, Balloon / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000379:methods; D003327:Coronary Disease / Q000517:prevention & control* / Q000601:surgery / Q000628:therapy; D006801:Humans; D012008:Recurrence; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents