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Published on: December 9, 2022
Saphenous Vein Graft Occlusion Following Native Vessel Chronic Total Occlusion Percutaneous Coronary Intervention
Spyridon Kostantinis, Bahadir Simsek, Judit Karacsonyi
1Minneapolis Heart Institute, 920 E 28th Street #300, Minneapolis, MN 55407 USA. esbrilakis@gmail.com.
Insights
Occluding saphenous vein grafts (SVGs) after successful native vessel chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is often performed. This strategy is linked to favorable mid-term outcomes, with low rates of target-lesion failure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- The optimal management of saphenous vein grafts (SVGs) after successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the native vessel is debated.
- SVGs can remain patent after CTO-PCI but may pose risks or complications.
Purpose of the Study:
- To evaluate the clinical and angiographic outcomes of SVG occlusion following successful native vessel CTO-PCI.
- To assess the safety and efficacy of SVG occlusion as a strategy after CTO-PCI.
Main Methods:
- A multicenter analysis of 51 patients undergoing SVG occlusion post-CTO-PCI between 2015 and 2022.
- Patients' clinical and angiographic data were collected, and procedural outcomes were analyzed.
- SVG occlusion was achieved using coils or vascular plugs.
Main Results:
- The majority of patients were male (80%), with a mean age of 71 ± 8 years.
- The right coronary artery was the most common target vessel for CTO-PCI.
- Successful SVG occlusion was achieved in all cases, with complete occlusion (TIMI 0 flow) in 75% of patients. Target-lesion failure incidence was 5.4% at mid-term follow-up.
Conclusions:
- SVG occlusion is frequently performed after successful native vessel CTO-PCI.
- The procedure is technically successful and associated with favorable mid-term clinical outcomes.
- SVG occlusion appears to be a safe and effective strategy in selected patients post-CTO-PCI.
Background:
Whether saphenous vein grafts (SVGs) should be occluded after successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) of the corresponding native vessel remains controversial.
Methods:
We analyzed the clinical and angiographic characteristics and procedural outcomes of 51 patients who underwent SVG occlusion following successful CTO-PCI of the corresponding native vessel between 2015 and 2022 at 14 centers.
Results:
Mean patient age was 71 ± 8 years and 80% were men. The most common CTO target vessel was the right coronary artery (41%), followed by the left circumflex (37%). Retrograde crossing through the SVG was the successful crossing strategy in 40 cases (78%). SVG occlusion was achieved with coils (1.9 ± 1.0) in 35 of 51 patients (69%) and vascular plugs in the other 16 cases (31%). All procedures were technically successful and the SVG was occluded completely (TIMI 0 flow) in 38 of the cases (75%), with the remaining cases having TIMI 1 flow. Follow-up was available for 37 patients (73%); during a mean follow-up of 312 days from CTO-PCI, the incidence of target-lesion failure due to restenosis was 5.4% (n = 2) with no other major events reported.
Conclusion:
Following native vessel CTO-PCI, SVG occlusion is often performed and is associated with favorable mid-term outcomes.
