Secondary prevention, the interventional way: prophylactic drug-eluting stents for nonobstructive saphenous vein graft disease.
نویسندگان
چکیده
The pathophysiology of accelerated atherosclerosis in saphenous vein grafts (SVG) relates to progressive atheroma burden, neointimal hyperplasia, and vascular remodeling.1,2 Unfortunately, the therapeutic and clinical consequences of SVG disease are not trivial, and interventional cardiologists are wary of performing percutaneous coronary interventions (PCI) on degenerated SVG. Intervening on flow-limiting stenoses in SVG has long been associated with high complication rates;3 what was not well known to this date was the risk of stenting non–flow-limiting disease in SVG.4 Although techniques to mitigate distal embolization during SVG intervention have proliferated in the past decade, even optimal intervention with embolic protection devices, including proximal protection devices, filters, aspiration tools, and covered stents, have attendant higher complication rates than does native vessel PCI.5 Drug-eluting stents (DES) are of benefit in reducing restenosis compared with bare metal stents in SVG, but clinical adverse events are only marginally reduced, if at all.6–8
منابع مشابه
Sealing Intermediate Nonobstructive Coronary Saphenous Vein Graft Lesions With Drug-Eluting Stents as a New Approach to Reducing Cardiac Events: A Randomized Controlled Trial.
BACKGROUND The objective of this study was to assess the efficacy of sealing intermediate nonobstructive coronary saphenous vein graft (SVG) lesions with drug-eluting stents (DES; paclitaxel- or everolimus-eluting stents) for reducing major adverse cardiac events (MACE). METHODS AND RESULTS This was a randomized controlled multicenter clinical trial that enrolled patients with a previous coro...
متن کاملLate outcomes of drug eluting and bare metal stents in saphenous vein graft percutaneous coronary intervention.
AIMS PCI with drug eluting stents (DES) has been shown to reduce restenosis and major adverse cardiac event (MACE) rates compared to bare metal stents (BMS) in native coronary vessels, although outcomes in saphenous vein graft (SVG) lesions are less clear. We retrospectively studied 388 consecutive patients admitted to our centre for SVG PCI to assess mortality and MACE outcomes (defined as com...
متن کاملAdvances in vein graft intervention
While saphenous vein grafts continue to serve as the most common conduit in coronary artery bypass surgery, within the first decade approximately 50% will have developed significant disease. Percutaneous coronary intervention is often undertaken in patients with saphenous vein graft disease as an alternative to reoperation, but is associated with an increased risk of distal embolization, no-ref...
متن کاملDrug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Intervention.
Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with higher adverse event rates, lower procedural success, and inferior longterm patency rates compared with native vessel PCI. The ability to comply with dual antiplatelet therapy, and whether the patient will need an interruption in dual antiplatelet therapy, should be considered when deciding whether to impl...
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ورودعنوان ژورنال:
- Circulation
دوره 120 20 شماره
صفحات -
تاریخ انتشار 2009