LIMITS OF REVASCULARIZATION - INTERVENTIO NAL TREATMENT OPTIONS FOR OCCLUSIONS AND RESTENOSIS AFTER BYPASS-SURGERY

Coronary artery bypass graft (CABG) surgery may be limited by incomple te revascularization, graft failure and progression of narrowing in th e native coronary arteries. Ischemia in the first year after CABG, ass ociated with anastomotic problems, can be safely and effectively treat ed with angioplasty. The rate of saphenous vein graft failure increase s rapidly 8 years after CABG. Interventional strategy depends largely on lesion morphology. Focal stenoses can be treated with stents, with primary success rates > 90% and complication rates < 5%. Diffusely deg enerated vein grafts and chronic total occlusions remain problematic f or all catheter-based interventions. No randomized trial exists compar ing reoperative CABG with angioplasty. In non-randomized data, neither therapy was clearly superior to the other. The underlying extent of d isease primarily determines long-term survival. This suggests that con trol of risk factors may well be beneficial. In patients with recurren t symptoms unresponsive to medical therapy, referral for revasculariza tion is reasonable. The choice of additional treatment may be made on the basis of clinical criteria and angiographic suitability, as well a s patient preference.