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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Preventing graft restenosis after coronary artery bypass grafting with tissue-type plasminogen activator
Ruixiong Li1, Bin Lan2, Tianxiang Zhu3
1Cardiothoracic Surgery, Shantou Central Hospital and Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, 515031, People's Republic of China. lirx2005@21cn.com.
Insights
Early tissue-type plasminogen activator (t-PA) application after coronary artery bypass grafting (CABG) appears safe and feasible. This approach may help prevent saphenous vein graft restenosis, though further trials are needed.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Vascular Biology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- Graft restenosis, particularly in saphenous vein grafts (SVGs), remains a significant challenge, leading to graft failure and adverse clinical outcomes.
- Preventing early graft failure and restenosis is crucial for long-term patient survival and quality of life.
Purpose of the Study:
- To assess the feasibility and safety of using tissue-type plasminogen activator (t-PA) as an adjunct therapy post-CABG.
- To investigate the potential of t-PA in preventing early saphenous vein graft restenosis.
- To compare graft patency and stenosis severity between patients receiving t-PA and those on conventional anticoagulation.
Main Methods:
- A prospective observational study involving 37 patients undergoing CABG.
- Patients were divided into two groups: t-PA (n=12) and conventional anticoagulation (n=25).
- The t-PA group received aspirin, clopidogrel, and a 3-day intravenous infusion of t-PA starting 24 hours post-surgery. The conventional group received aspirin and clopidogrel.
- Graft patency was evaluated using computed tomographic coronary angiography at 1 week, 1 month, and 3 months post-surgery.
Main Results:
- Mean stenosis severity in saphenous vein grafts was significantly lower in the t-PA group at 3 months (p < 0.05).
- No significant differences in stenosis severity were observed at 1 week and 1 month between groups (p > 0.05).
- Graft patency rates did not differ significantly between the t-PA and conventional groups at any time point (p > 0.05).
Conclusions:
- Early administration of t-PA following CABG is feasible and safe.
- t-PA may play a role in mitigating early saphenous vein graft restenosis.
- Further robust clinical randomized trials are warranted to confirm these preliminary findings and establish definitive efficacy.
Objective:
To explore the feasibility and safety of using tissue-type plasminogen activator (t-PA) to prevent graft restenosis after coronary artery bypass grafting (CABG).
Methods:
In this prospective observational study, 37 patients underwent CABG between June 2009 and May 2013. These patients were grouped according to the anti-coagulation strategy after surgery: t-PA (n = 12) and conventional treatments (n = 25). In the t-PA group, the patients received acetylsalicylic acid (ASA) and clopidogrel plus intravenous infusion of t-PA (0.25 mg/kg/day) starting at 24 h after surgery and that lasted for 3 days. In the conventional group, the patients received only ASA and clopidogrel. 64-row spiral computed tomographic coronary angiography was performed at 1 week, 1, and 3 months after surgery to evaluate the patency of the graft vessel.
Results:
The mean stenosis severity of the saphenous vein grafts was lower in the t-PA group compared with the conventional group at 3 months after surgery (p < 0.05), but there was no significant difference at 1 week and 1 month (p > 0.05). The patency rate of the grafts was not significantly different between the two groups at 1 week, 1, and 3 months after surgery (p > 0.05).
Conclusion:
Early application of t-PA after CABG was feasible and safe, and might help prevent early restenosis of SV grafts. Additional clinical randomized trials are necessary to address this issue.
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