Percutaneous coronary intervention of totally occluded coronary venous bypass grafts:An exercise in futility?  

作　　者：Evan W Nardone Brandon M Madsen Melissa M McCarey David L Fischman Nicholas J Ruggiero Paul Walinsky Alec Vishnevsky Michael P Savage 

机构地区：[1]Department of Medicine,Thomas Jefferson University,Philadelphia,PA 19107,United States [2]Department of Anesthesiology,Medstar Georgetown University Hospital,Washington,DC 20007,United States [3]Jefferson Clinical Research Institue,Thomas Jefferson University,Philadelphia,PA 19107,United States

出　　处：《World Journal of Cardiology》2021年第9期493-502,共10页世界心脏病学杂志（英文版）（电子版）

摘　　要：BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes.

关 键 词：Coronary artery bypass grafting Coronary stents Chronic total occlusion Percutaneous coronary intervention RESTENOSIS Saphenous vein grafts 

分 类 号：R654.2[医药卫生—外科学]