title: Saphenous vein graft intervention.
abstract: Saphenous vein grafts are commonly used conduits for surgical revascularization of coronary arteries but are associated with poor long-term patency rates. Percutaneous revascularization of saphenous vein grafts is associated with worse clinical outcomes including higher rates of in-stent restenosis, target vessel revascularization, myocardial infarction, and death compared with percutaneous coronary intervention of native coronary arteries. Use of embolic protection devices is a Class I indication according to the American College of Cardiology/American Heart Association guidelines to decrease the risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Nonetheless, these devices are underused in clinical practice. Various pharmacological agents are available that may also reduce the risk of or mitigate the consequences of no-reflow. Covered stents do not decrease the rates of periprocedural myocardial infarction and restenosis. Most available evidence supports treatment with drug-eluting stents in this high-risk lesion subset to reduce angiographic and clinical restenosis, although large, randomized trials comparing drug-eluting stents and bare-metal stents are needed.
authors.affiliation: University of California-Los Angeles Medical Center, Los Angeles, California, USA. mslee@mednet.ucla.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: David E
authors.initials: DE
authors.lastname: Kandzari
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Paul
authors.initials: P
authors.lastname: Vermeersch
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D000991:Antithrombins / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000601:surgery*; D023903:Coronary Restenosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D057505:Embolic Protection Devices; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000991:Antithrombins; D010975:Platelet Aggregation Inhibitors