Saphenous Vein Graft Disease Interventions
| Autor: | Sarita Rao, K. Roshan Rao, Achukatla Kumar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
RD1-811 medicine.medical_treatment Immunology Activated clotting time Balloon embolic protection device Angioplasty saphenous vein graft medicine Myocardial infarction cardiovascular diseases distal embolization medicine.diagnostic_test business.industry percutaneous coronary intervention no reflow phenomenon Stent Percutaneous coronary intervention medicine.disease Surgery medicine.anatomical_structure surgical procedures operative Conventional PCI business Artery |
| Zdroj: | Indian Journal of Cardiovascular Disease in Women, Vol 06, Iss 03, Pp 199-208 (2021) |
| ISSN: | 2455-7854 |
| DOI: | 10.1055/s-0041-1736323 |
| Popis: | In the current era, coronary artery bypass grafting (CABG) is being increasingly performed using total arterial revascularization or a hybrid procedure of stenting of non-LAD disease and minimal access left internal mammary artery (LIMA) to LAD grafts, in order to minimize the need for vein grafts. Still, we encounter saphenous vein graft (SVG) disease, and it might require PCI, which often presents with unique challenges. The current favored strategy is to attempt PCI of the native coronary, if feasible, especially in long degenerated SVG disease, as it has shown better short- and long-term outcome. PCI is preferred over repeat CABG for early recurrent symptoms after CABG in patent LIMA graft and amenable anatomy patients. Balloon predilatation is not recommended unless delivery of an EPD or stent is not possible. Distal protection should be considered the standard of care for percutaneous coronary intervention (PCI) in most patients with older vein grafts, as periprocedural myocardial infarction and no reflow are the Achilles heel of SVG PCI. Intragraft vasodilators should be used liberally, even before balloon angioplasty/stenting. Avoid postdilatation, and usage of undersized but a longer stent length to reduce plaque extrusion through stent struts is preferred. Consider thrombectomy in lesions with a heavy thrombus burden. Keep activated clotting time on the higher side than in conventional PCI. Prolonged dual antiplatelet therapy (DAPT) based on the DAPT score is recommended. With all the precautions and care, we still need a fair wind in our favor to sail through the vein grafts disease. |
| Databáze: | OpenAIRE |
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