Percutaneous catheter-based repeat revascularization in patients with previous PCI or CABG: a comprehensive review of the evidence

George Jose Valooran,Mohamad Bashir,Mohammed Idhrees,Mukesh Karuppannan,Bashi Velayudhan,Meenakshi Subbiah

doi:10.20517/2574-1209.2021.85

Abstract

Repeat revascularization after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is one of the most common long-term complications which warrants continuous clinical follow up. Re-interventions negatively impact long-term survival in patients with coronary artery disease. The repeat revascularization after PCI can be either a target lesion revascularization (stent thrombosis/in-stent restenosis) or a revascularization of native coronary artery after PCI (target vessel revascularization/non-target vessel revascularization). The EVENT registry reports that repeat revascularization rates in patients undergoing PCI is 12% in the first year of follow up. Repeat revascularization with additional stent deployment increases the rate of stent thrombosis and restenosis, thereby leading to recurrent ischemic events. Repeat revascularization after CABG can be either in the early postoperative period or later due to native disease progression or late graft stenosis. The need for re-intervention after surgical or percutaneous revascularization is inevitable and is dependent on modifiable and non-modifiable risk factors.

Highlights

The evolution of percutaneous coronary intervention (PCI) techniques and tools has been tremendous in the last few decades, which has enabled the interventional cardiologist to treat increasingly complex lesions with fewer complications
PCI is the primary choice of re-intervention in repeat revascularizations after index PCI or coronary artery bypass grafting (CABG), as evident from the recent literature[5], and this review focuses on the evidence supporting the approach
A second-generation DES is the preferred choice of stent in re-interventions after PCI, which is adequately backed by evidence

Summary

Introduction

The evolution of PCI techniques and tools has been tremendous in the last few decades, which has enabled the interventional cardiologist to treat increasingly complex lesions with fewer complications. Re-intervention following CABG is morbid and is indicated with early or late graft failures or progression of disease in the native coronaries.

Results

Conclusion