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Palmaz-Schatz stenting for treatment of focal vein graft stenosis: Immediate results and long-term outcome

1994; Elsevier BV; Volume: 23; Issue: 6 Linguagem: Inglês

10.1016/0735-1097(94)90370-0

1558-3597

Robert N. Piana, Mauro Moscucci, David J. Cohen, Aaron D. Kugelmass, Cynthia Senerchia, Richard E. Kuntz, Donald S. Baim, Joseph P. Carrozza,

Cardiac and Coronary Surgery Techniques

Objectives. This study aimed to evaluate the effectiveness of Palmaz-Schatz stenting for the treatment of saphenous vein graft stenoses. Background. Failure of saphenous vein grafts is a common cause of recurrent ischemia after coronary bypass surgery. A second bypass surgery carries more risk than the initial procedure, and balloon angioplasty of vein grafts has yielded disappointing results. It has been hoped that starting might offer a better treatment option. Methods. We examined the results of stent placement in 200 saphenous bypass graft lesions consecutively treated with either coronary (n = 146) or biliary (n = 54) Palmaz-Schatz stents. Immediate outcome and clinical follow-up (median 15.5 months) were examined in all patients. To document angiographic outcome, a second angiography was performed at 3 to 6 months for the first 120 consecutively stented lesions and was successfully obtained for 94 (78%). Results. The mean graft age (±SD) was 8.7 ± 4 years. Stent placement was successful in 197 (98.5%) of 200 lesions, reducing the mean diameter stenosis from 74 ± 14% to 1 ± 15%. In 164 procedures, there was one in-hospital death (0.6%), no emergency bypass operations and no Q wave myocardial infarctions. There was one acute stent thrombosis (0.6%) but no subacute thromboses. Vascular repair was required after 14 procedures (8.5%), with transfusion in 23 additional cases (14%). Angiographic restenosta (diameter stenosis ≥ 50%) at 3- to 6-month follow-up was 17% (95% confidence interval 9% to 25%). By Kapian-Meier estimates, however, the 2-year second revascularization rate was 49%, refecting the predominant revascularization performed to treat progressive disease at other sites because failure at the stented site occurred in only 22% of lesions. Conclusions. Stenting resulted in exellent immediate and long-term angiographic resuls in this group of focally diseased, older saphenous vein grafts. Despite the high immediate success and very low (17%) angiographic restenesis rate at 6 months, approximately one half of these patients required farther revascularization in the following 2 years, mainly because of disease progression at other sites.