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您的检索式：作者名="Paul Walinsky"
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| 1 | Percutaneous coronary intervention of totally occluded coronary venous bypass grafts:An exercise in futility?显示文摘BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical challenge.Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG.However,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet therapy.AIM To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODS This was a retrospective observational study conducted at a single university hospital.The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG.Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely.Clinical outcomes were assessed at a mean follow-up of 1221±1038 d.The primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft reocclusion.RESULTS The study group included 29 men and 6 women with a mean age of 69±12 years.Diabetes was present in 14(40%)patients.All patients had Canadian Heart Classification class III or IV angina.Clinical presentation was an acute coronary syndrome in 34(97%)patients.Mean SVG age was 12±5 years.Estimated duration of occlusion was acute(<24 h)in 34%of patients,subacute(>24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 mm.Intraprocedural complications of distal embolization or no-reflow occurred in 6(17%)patients.During longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 years.CONCLUSION PCI of totally occluded SVG can be performed with a high procedural success rate.However,its clinical utility remains limited by poor follow-up outcomes. | Evan W Nardone Brandon M Madsen Melissa M McCarey David L Fischman Nicholas J Ruggiero Paul Walinsky Alec Vishnevsky Michael P Savage | 2021 | World Journal of Cardiology2021，13，9： | 0 |
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