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  • Title: Chronic total occlusion treatment in post-CABG patients: saphenous vein graft versus native vessel recanalization-long-term follow-up in the drug-eluting stent era.
    Author: Meliga E, García-García HM, Kukreja N, Daemen J, Tanimoto S, Ramcharitar S, van Mieghem CA, Sianos G, van der Ent M, van der Giessen WJ, de Feyter P, van Domburg R, Serruys PW.
    Journal: Catheter Cardiovasc Interv; 2007 Jul 01; 70(1):21-5. PubMed ID: 17584913.
    Abstract:
    OBJECTIVE: To compare the postprocedural and long-term clinical outcomes of two groups of patients, all presenting with chronic saphenous vein graft (SVG) occlusion, who underwent either SVG or native vessel reopening. BACKGROUND: Chronic total occlusions (CTO) treatment in patients who underwent previous surgical revascularization is a dilemma and the choice of performing native vessel or SVG recanalization is not always easy. METHODS: Between July 2002 and October 2004, a total of 260 patients were successfully treated for a CTO. Of them, we selected all patients (n = 24) who had previous bypass surgery with graft occlusion. Of this final group, 13 patients underwent a percutaneous graft recanalization while 11 underwent native vessel reopening. RESULTS: Primary end points were in-hospital and 3-year rates of death, myocardial infarction, target lesion revascularization, and target vessel revascularization. No events occurred in either group during the in-hospital period. Cumulative 3-year event-free survival in the native vessel and SVG group was 81.8% and 83.9% respectively (P = NS). One death and one TVR occurred in each group. CONCLUSION: In selected cases, SVG reopening instead of the native vessel is feasible. In such a high-risk population, drug-eluting stent implantation in both SVG and native CTO lesions is associated with good long-term outcomes.
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