Percutaneous coronary intervention after CABG: An evolving paradigm

This review evaluates revascularization strategies following coronary artery bypass grafting (CABG), focusing on the management of graft failure after initial surgery. While redo CABG has been the traditional approach, its significant procedural risks, elevated perioperative mortality, and extended recovery have prompted a shift toward minimally invasive alternatives such as percutaneous coronary intervention (PCI). Nevertheless, redo CABG operations have seen a staggering decline over the last 20 years. To date, randomized clinical trials comparing a strategy of native vessel PCI with SVG PCI have not been conducted. This paper examines the evolving role of PCI in post-CABG patients, with a particular emphasis on the benefits of native vessel PCI over graft interventions. Advances in drug-eluting stents (DES) and intravascular imaging modalities have significantly improved PCI's safety and efficacy, broadening its applicability to diverse patient populations. Native vessel PCI demonstrates superior long-term outcomes by mitigating risks of restenosis and adverse cardiac events, outperforming saphenous vein graft PCI, which is frequently complicated by embolization and graft degeneration. Although redo CABG remains indispensable for select cases involving complex coronary anatomy or multivessel disease, PCI offers comparable survival outcomes with lower procedural morbidity, making it a preferred option for high-risk cohorts. This review highlights the clinical impact of these advancements, supports personalized decision-making in post-CABG revascularization, and underscores the importance of further research to refine guidelines and optimize therapeutic outcomes.