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PCI Post-CABG SVG Disease — RACP Adult Medicine MCQ

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HardCardiologyPCI Post-CABG SVG DiseaseRACP Adult Medicine

A 70-year-old man with a history of coronary artery bypass grafting (saphenous vein grafts) 15 years ago presents with recurrent angina. Coronary angiography shows severe disease in the native LAD (90% stenosis), patent LIMA-LAD graft, and severe disease in the saphenous vein graft to the RCA (95% stenosis). What is the most appropriate management?

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Correct answer: B — PCI to SVG-RCA

Recurrent angina post-CABG with patent LIMA graft (good long-term patency) but diseased SVG (SVGs have limited durability — ~50% occlude by 10 years) warrants PCI to the SVG or native vessel. PCI to SVG-RCA with a distal embolic protection device (to prevent atheroembolic shower from friable SVG plaque) is appropriate. Redo CABG carries higher surgical risk and is reserved for extensive native vessel disease not amenable to PCI. The patent LIMA-LAD is the most important graft and should be protected.

Reference: CSANZ – 2025 – Revascularisation; ESC 2024 CCS