Angioplasty of Bypass Surgery Graft
Progression of disease in native coronary arteries occurs in approximately 5 % of patients annually during first 10 years.
At 10 years, only 40% of patent grafts are free of significant stenosis. Arterial grafts are superior. As compared with Saphenous graft (SVG), internal mammary grafts conferred a survival advantages throughout a 15 years follow up. Angoplasty of SVG grafts is rapidly changing and continues to be an ongoing challenge for the interventional cardiologist. As compared to angioplasty of native vessels, graft vessel angioplasty is associated with sub-optimal results, increased major adverse cardiac events and less favorable long-term results. The arrival of stents, better antithrombotic medication, distal protection and thrombectomy devices have made it possible to attempt interventions in larger number of patients and obtain favorable results.
Why Angioplasty is preferred over second (Redo) bypass surgery
- Limited myocardium now in jeopardy if some grafts are patent
- Risk to patent grafts during resternotomy
- Lack of suitable conduits
- Poor LV function
- Advanced age
- Co-existing medical problems.
SVG graft disease
Atheromas begin to appear at 3-5 years
- Atheromas are frequently bulky and friable
- “Silent” thrombus is common
- Direct Stenting
- Embolic Protection ( proximal, distal protection)
- Thrombus management
- Undersized stent
- Net Protective Stent MGUARD