Treatment of Saphenous Vein Graft Disease
The use of bare stents for the percutaneous intervention of saphenous vein bypass grafts (SVGs) is associated with a high subsequent rate of restenosis. To assess the impact of the sirolimus-eluting stent (SES), we studied 19 consecutive patients who underwent de novo SVG intervention treated solely with SES. Mean graft age was 10 years. Clinical presentation was an acute coronary syndrome in 68%. In total, twenty-two de novo lesions were treated with 35 SESs (mean, 1.6 stents per lesion). Use of glycoprotein IIb/IIIa inhibitor therapy and distal embolization protection device were at operator discretion and were 42% and 32%, respectively. The rate of in-hospital major adverse cardiac events (MACE) was 11%, related to 2 patients with a creatine kinase rise consistent with peri-procedural acute myocardial infarction (AMI); a distal protection device was not utilized in either. Over a mean 12.5 ± 2.6 month follow-up, one patient died from a non-cardiac cause, and there were no further AMIs. Target lesion revascularization was undertaken in 1 patient (5%); survival free of MACE was 84%. In conclusion, utilizing SESs for percutaneous intervention of degenerate SVGs is associated with a low rate of target vessel revascularization. Increased utilization of distal protection devices might reduce the peri-procedural rate of AMI.
Coronary artery bypass grafting (CABG) is not a definitive therapy and patients continue to have considerable cardiovascular morbidity and mortality. Recurrence of angina occurs in 5-10% of patients each year, related to either progression of native vessel atherosclerosis or failure of the bypass grafts. Indeed, angiographic studies have shown that by 10-12 years, 75-79% of saphenous vein grafts (SVGs) are occluded or severely diseased.
Revascularization with repeat CABG surgery is associated with increased mortality than a first operation, and less symptomatic improvement. Percutaneous revascularization is therefore an attractive alternative strategy. However, although stent implantation is superior to balloon-alone angioplasty, follow-up shows a high 6-month restenosis rate of 37-53%. Drug-eluting stents have been shown to be highly successful in reducing restenosis in native coronary disease in a select patient population. This study evaluates the sirolimus-eluting stent (SES) in a high-risk population of patients undergoing intervention in diseased SVGs.
The use of bare stents for the percutaneous intervention of saphenous vein bypass grafts (SVGs) is associated with a high subsequent rate of restenosis. To assess the impact of the sirolimus-eluting stent (SES), we studied 19 consecutive patients who underwent de novo SVG intervention treated solely with SES. Mean graft age was 10 years. Clinical presentation was an acute coronary syndrome in 68%. In total, twenty-two de novo lesions were treated with 35 SESs (mean, 1.6 stents per lesion). Use of glycoprotein IIb/IIIa inhibitor therapy and distal embolization protection device were at operator discretion and were 42% and 32%, respectively. The rate of in-hospital major adverse cardiac events (MACE) was 11%, related to 2 patients with a creatine kinase rise consistent with peri-procedural acute myocardial infarction (AMI); a distal protection device was not utilized in either. Over a mean 12.5 ± 2.6 month follow-up, one patient died from a non-cardiac cause, and there were no further AMIs. Target lesion revascularization was undertaken in 1 patient (5%); survival free of MACE was 84%. In conclusion, utilizing SESs for percutaneous intervention of degenerate SVGs is associated with a low rate of target vessel revascularization. Increased utilization of distal protection devices might reduce the peri-procedural rate of AMI.
Coronary artery bypass grafting (CABG) is not a definitive therapy and patients continue to have considerable cardiovascular morbidity and mortality. Recurrence of angina occurs in 5-10% of patients each year, related to either progression of native vessel atherosclerosis or failure of the bypass grafts. Indeed, angiographic studies have shown that by 10-12 years, 75-79% of saphenous vein grafts (SVGs) are occluded or severely diseased.
Revascularization with repeat CABG surgery is associated with increased mortality than a first operation, and less symptomatic improvement. Percutaneous revascularization is therefore an attractive alternative strategy. However, although stent implantation is superior to balloon-alone angioplasty, follow-up shows a high 6-month restenosis rate of 37-53%. Drug-eluting stents have been shown to be highly successful in reducing restenosis in native coronary disease in a select patient population. This study evaluates the sirolimus-eluting stent (SES) in a high-risk population of patients undergoing intervention in diseased SVGs.
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