ABSTRACT
Premature atherosclerosis is the major factor contributing to saphenous vein bypass grafts (SVGs) attrition and accounts for the majority of acute ischemic syndromes in the post-coronary artery bypass graft (CABG) patient. The use of the internal mammary artery (IMA) and other arterial conduits revolutionized CABG because of the relative resistance of arterial conduits to accelerated atherosclerosis compared with SVGs. Recurrent ischemic events occur in a time-dependent manner and may result from progression of disease in the native coronary arteries. However, the most common cause of adverse cardiac events in the post-CABG patient is atherosclerosis and attrition of SVGs. The favorable angiographic and clinical outcomes observed after stenting native coronary arteries provided a rationale for investigating the use of stents for the treatment of SVG disease. Adjunctive excimer laser before balloon angioplasty of SVGs has been evaluated in retrospective studies; however, its use has been plagued by a high rate of restenosis and total occlusion.
