ABSTRACT
Recurrence of ischemia and angina after coronary artery bypass graft surgery (CABG) relates to either progression of native vessel atherosclerosis or failure of the bypass grafts themselves. Indeed, angiographic studies have shown that by 10-12 years, 75-79% vein grafts are occluded or severely diseased.73,74
Moreover, it has been also shown that the bypass operation may accelerate disease progression within the native vessels.75,76 Therefore, recurrence of anginal symptoms occurs relatively frequently following CABG,77 a condition that may lead to the need for further revascularization. However, repeat CABG surgery is associated with a higher mortality rates compared to a first operation.78,79 In this context, percutaneous revascularization may be an attractive therapeutic strategy. Unfortunately, stent implantation in venous bypass grafts carries a high subsequent rate of restenosis of 37-53%.80,81 Furthermore, lesions located at the native coronary bed of patients with prior CABG frequently carry a high risk of restenosis, because of the common frequency of chronic total occlusions and lesions located at peripheral segments with a small caliber, among others reasons. This chapter analyses the impact of sirolimus-eluting stents for patients with previous CABG treated in RESEARCH.
