Secondary coronary revascularisation

Summary

The need for secondary coronary revascularisation is growing worldwide. Given the chronic nature of atherosclerotic disease, in conjunction with an ageing population, many patients with cardiovascular disease will undergo crossed surgical and percutaneous coronary interventions during their lifetime. Patients requiring repeat coronary interventions typically fall into higher risk categories and have multiple comorbidities including diabetes, chronic renal failure and peripheral vascular disease. High atherosclerotic burden in native coronaries, saphenous graft attrition and stent failure contribute to the increased risk and complexity faced in this challenging clinical subset. This chapter addresses the crossed modalities of secondary revascularisation. Attention is paid to percutaneous intervention of surgical conduits and native vessels in patients with prior surgical coronary revascularisation. The application of crossed intervention in the management of acute percutaneous and graft failure is also discussed. The authors stress the importance of the heart team for decision making in secondary revascularisation and insist on the importance of avoiding ad hoc, episodic care in this challenging group of patients.

Secondary coronary revascularisation

The possibility that an individual cardiovascular patient will require more than one coronary intervention has increased substantially over the last two decades due to several factors 11. Escaned J....