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CABG Graft Disease — EECC MCQ

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HardCoronary Artery DiseaseCABG Graft DiseaseEECC

A 72-year-old man had CABG 15 years ago with LIMA to LAD, SVG to OM1, and SVG to RCA. He presents with recurrent angina. Angiography shows a patent LIMA-LAD, occluded SVG to OM1, and a 90% stenosis in the SVG to RCA. What is the recommended approach to the SVG disease?

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Correct answer: E — PCI to the native RCA vessel if feasible, rather than intervention on the diseased SVG

Late SVG disease (>5 years post-CABG) is characterised by diffuse atherosclerosis, friable plaque, and high embolic risk during intervention. Current practice favours PCI to the native coronary vessel when technically feasible, as this avoids the embolic complications of SVG intervention and provides better long-term outcomes. If native vessel PCI is not feasible, SVG PCI with a DES and embolic protection device (EPD) should be used. The LIMA-LAD graft has excellent long-term patency (>90% at 15 years) and is rarely diseased. Redo CABG carries significantly higher operative risk than primary CABG.

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