7 Deteriorating SVG lesions also possess thinner, more friable fibrous caps compared with native coronary artery lesions. 14 Increased pressure load from vein graft arterialisation induces this development of neointimal growth and atherosclerosis. 8–14 Occlusions after 12–18 months occur following lipid deposition within intimal hyperplasia, eventually forming atherosclerotic plaque. 7 Platelet aggregation, growth factor secretion, endothelial dysfunction, inflammation, luminal foam cell accumulation, decreased local fibrinolytic potential from plasminogen activator inhibitor-1 upregulation and marked intimal hyperplasia contribute to SVG occlusion within the first 12–18 months post-CABG. Approximately 10–15 % of SVGs occlude within 1 year and 50 % fail by 10 years. Various factors contribute to SVG deterioration and occlusion, which may ultimately require revascularisation. Pathophysiology of Saphenous Vein Graft Complications In this review, we discuss risk factors for SVG intervention and the optimal approaches for treating this challenging subset of patients. Percutaneous coronary intervention (PCI) of SVGs is associated with worse clinical outcomes compared with native coronary artery PCI, 5,6 but certain strategies may help mitigate complications. 1–4 SVG neointimal hyperplasia and accelerated atherosclerosis diminish the long-term benefits of CABG, while subsequent SVG interventions are plagued by plaque embolisation and no-reflow phenomenon. Previous reports suggest rates of SVG failure in the first 12–18 months may be as high as 25 %. However, SVGs are prone to both degeneration and occlusion, leading to poor long-term patency compared with arterial grafts. Saphenous vein grafts (SVGs) are commonly used during coronary artery bypass graft surgery (CABG) for severe coronary artery disease. The optimal pharmacological treatment for slow or no-reflow remains unclear, but various vasodilators show promise. The ACCF/AHA/SCA American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions guidelines recommend the use of EPDs during SVG intervention to decrease the risk of periprocedural MI, distal embolisation and no-reflow. Regarding stent selection, evidence has demonstrated superiority of drug-eluting stents over bare-metal stents in SVG intervention. To minimise complications seen with these interventions, proper stents, embolic protection devices (EPDs) and pharmacological selection are crucial. Interventions used to treat SVG disease are susceptible to high rates of periprocedural MI and no-reflow. InspireMD's coronary EPS is CE Mark approved.Saphenous vein grafts (SVGs), used during coronary artery bypass graft surgery for severe coronary artery disease, are prone to degeneration and occlusion, leading to poor long-term patency compared with arterial grafts. The company notes that in coronary procedures, InspireMD's EPS technology has shown improvements through the MASTER trial findings that revealed a statistically and clinically significant acute advantage of MGuard EPS with regard to ST segment resolution. MGuard is not approved for sale in the United States. In markets that recognize the CE Mark, the new InspireMD carotid EPS stent will be available in a matrix of sizes ranging from small diameters of 5 X 20 mm to large diameters up to 10 X 60 mm for large carotid arteries. The MicroNet is designed to hold plaque and thrombus in place against the wall of the blocked artery, preventing debris from falling into the bloodstream and causing a potentially fatal downstream blockage or stroke. The carotid EPS device is based on the company's MicroNet mesh protection platform technology that is also used for the treatment of myocardial infarction patients in InspireMD's commercially available coronary MGuard and MGuard Prime EPS devices.Īccording to the company's press release, the InspireMD carotid EPS is wrapped with a MicroNet mesh to prevent embolic events during and after carotid artery stent procedure. (Tel Aviv, Israel) announced that the company received CE Mark approval for its self-expanding nitinol carotid embolic protection stent (EPS).
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