Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.493
Peer-review started: March 24, 2021
First decision: May 5, 2021
Revised: May 27, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 26, 2021
Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Given low success rates, high complication rates, and poor long term patency, current cardiovascular guidelines have a class III recommendation against PCI for chronically occluded SVG.
Contemporary outcomes of SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy. There is a paucity of studies on the outcome of PCI for totally occluded SVG using current techniques.
The goal of this study was to reassess the procedural and long term outcome of PCI for totally occluded SVG with contemporary techniques in the drug-eluting stent era.
This was a retrospective observational study of 35 consecutive patients undergoing PCI of totally occluded SVG. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as any of the following: Death, myocardial infarction, stroke, repeat revascularization of the target vessel, or graft reocclusion. Mean follow-up was 1221 ± 1038 d.
The study group included 29 men and 6 women aged 69 ± 12 years. Mean SVG age was 12 ± 5 years. PCI was initially successful in 29/35 (83%) SVG occlusions. During long term follow-up, MACE-free survival was 30% at 3 years and 17% at 5 years.
PCI of totally occluded SVG can be performed with a relatively high rate of procedural success. However, the vast majority of patients have a major clinical event within a few years following the procedure. Thus, the clinical utility of PCI for totally occluded SVG continues to be limited by poor long term outcomes.
Although PCI of totally occluded SVG can be often initially accomplished, the long term clinical outcome remains poor. Future research is required to achieve a more sustained clinical benefit through further innovations in stent design and adjunct pharmacology.