医学
传统PCI
心脏病学
经皮冠状动脉介入治疗
内科学
围手术期
冠状动脉疾病
再狭窄
阿司匹林
外科
血运重建
心肌梗塞
支架
作者
Iosif Xenogiannis,Marco A. Zenati,Deepak L. Bhatt,Sunil V. Rao,Josep Rodés‐Cabau,Steven Goldman,Kendrick A. Shunk,Kreton Mavromatis,Subhash Banerjee,Khaldoon Alaswad,Ilias Nikolakopoulos,Evangelia Vemmou,Judit Karácsonyi,Dimitrios Alexopoulos,M. Nicholas Burke,Vinayak Bapat,Emmanouil S. Brilakis
出处
期刊:Circulation
[Ovid Technologies (Wolters Kluwer)]
日期:2021-08-31
卷期号:144 (9): 728-745
被引量:78
标识
DOI:10.1161/circulationaha.120.052163
摘要
Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible.
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