Bypass graft stenting is a minimally invasive procedure used to treat narrowed or blocked coronary bypass grafts in patients who previously underwent coronary artery bypass grafting (CABG). With modern techniques and devices, stenting can safely restore blood flow and relieve symptoms without repeat surgery.
Bypass graft stenting restores blood flow in blocked grafts and provides effective symptom relief without repeat surgery.
Why Bypass Graft Stenting Is Needed
Over time, bypass grafts—especially saphenous vein grafts (SVGs)—can develop:
- Progressive atherosclerosis
- Graft degeneration or thrombosis
- Restenosis at anastomotic sites
Patients may experience:
- Recurrent chest pain (angina)
- Shortness of breath
- Acute coronary syndrome
Types of Bypass Grafts
-
Saphenous Vein Grafts (SVGs) -
most commonly affected -
Arterial grafts (LIMA/RIMA/Radial) -
better long-term patency but may still develop focal disease
How Bypass Graft Stenting Is Performed
- Coronary angiography to identify graft anatomy
- Vascular access via radial or femoral artery
- Wiring of the diseased graft
- Embolic Protection Device (EPD) use (strongly recommended for SVGs)
- Balloon angioplasty and drug-eluting stent placement
- Post-dilatation to ensure optimal stent expansion
How Bypass Graft Stenting Is Performed
- Coronary angiography to identify graft anatomy
- Vascular access via radial or femoral artery
- Wiring of the diseased graft
- Embolic Protection Device (EPD) use (strongly recommended for SVGs)
- Balloon angioplasty and drug-eluting stent placement
- Post-dilatation to ensure optimal stent expansion
Procedure time: 45–90 minutes
Hospital stay: Usually 1–2 days
Special Considerations in SVG PCI
- High risk of distal embolization and no-reflow
- Routine use of embolic protection devices improves safety
- Drug-eluting stents preferred over bare-metal stents
- Native vessel PCI may be preferred when feasible
Indications for Bypass Graft Stenting
- Symptomatic graft disease causing angina
- Acute coronary syndrome involving a graft
- High surgical risk for repeat bypass surgery
- Focal, treatable graft lesions
Benefits of Bypass Graft Stenting
- Avoids repeat open-heart surgery
- Rapid symptom relief
- Shorter recovery time
- Minimally invasive
Safety & Outcomes
- High procedural success in experienced centers
- Better outcomes in focal lesions and early intervention
- Long-term success depends on risk factor control and medication adherence
Post-Procedure Care
- Dual antiplatelet therapy (DAPT)
- Aggressive lipid lowering (high-intensity statins)
- Blood pressure and diabetes control
- Lifestyle modification and cardiac rehabilitation
Indian Context
- Large number of post-CABG patients due to high CAD burden
- SVG degeneration commonly seen 5–10 years after surgery
- Advanced PCI techniques widely available in tertiary centers in India
Key Takeaways
- Bypass graft disease is common years after CABG
- Stenting is preferred over redo surgery in most cases
- Embolic protection devices improve safety in SVG PCI
- Native vessel PCI may be considered when suitable
- Long-term success depends on secondary prevention
