Percutaneous coronary intervention strategy of coronary bypass graft failure

Saphenous vein graft (SVG) lesions remain one of the most challenging problems for interventional cardiologists. Procedures performed in patients with SVG lesions are often more complex and are associated with higher risk than those in patients with native vessel percutaneous coronary intervention (PCI). Long-term benefi ts are also limited in this condition. There are several factors infl uencing the outcomes of SVG PCI including (1) diffi culties in graft localization and engagement, (2) high rates of periprocedural myocardial infarction (MI) caused by distal embolization in SVGs, and (3) high restenosis rates. However, PCI is generally preferred instead of surgical revascularization. Factors favoring PCI include limited areas of ischemia causing symptoms, suitable PCI targets, a patent graft to the left anterior descending artery (LAD), poor coronary artery bypass graft (CABG) targets, and comorbid conditions.