Stenting of Saphenous Vein Grafts with Drug Eluting Stents – Maybe Not as Good as in Native Vessels

S ince the introduction by Floyd Loop at the ClevelandClinic of the internal mammary artery (IMA) as anarterial graft to bypass the left anterior descending artery (LAD), it has been the gold standard conduit for revascularization, principally because it demonstrated its potent survival benefit in the long term follow-up.1 However, patients with multivessel coronary artery disea-se (CAD) undergoing coronary artery bypass graft (CABG) still required the saphenous vein grafts (SVG) as a bypass conduit to non-LAD coronary arteries and unlike the extremely high durability and patency rates for the LIMA graft, 50 % of SVGs develop severe disease or occlusion at 10 years. Over the last decades, percutaneous coronary in-tervention (PCI) has offered a less invasive revasculari-zation alternative compared to CABG, particularly for patients with less extensive obstructive CAD. Interven