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Native Vessel PCI Post-CABG — EECC MCQ

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HardCoronary Artery DiseaseNative Vessel PCI Post-CABGEECC

A 68-year-old woman with a history of CABG 8 years ago is admitted with NSTEMI. Angiography shows patent LIMA-LAD, occluded SVG-OM, and a new severe native LCx disease. The interventionalist considers PCI to the native LCx. What specific technical challenge must be anticipated?

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Correct answer: D — The native LCx may have undergone competitive flow-induced atrophy and chronic total occlusion, making PCI technically demanding

In post-CABG patients, native coronary arteries that were previously bypassed may undergo progressive disease due to competitive flow from the graft (reducing antegrade native flow) and ongoing atherosclerosis. When SVGs occlude, the native vessel may have developed a CTO or severe diffuse disease, making PCI technically challenging (calcification, tortuosity, small vessel calibre). Despite these challenges, PCI to native vessels is preferred over degenerated SVG PCI when feasible, due to better long-term outcomes. Careful assessment of native vessel anatomy, collateral supply, and CTO crossing strategies is essential. Hybrid approaches (using both native and graft access) may be employed.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes