title: Comparative results of transluminal extraction coronary atherectomy in saphenous vein graft lesions with and without thrombus.
abstract: OBJECTIVE
  The purpose of this retrospective study was to compare the results of transluminal extraction coronary atherectomy in saphenous vein graft lesions with and without angiographic thrombus.
  
  
  BACKGROUND
  Percutaneous interventions in lesions with thrombus are associated with reduced procedural success and increased risk of complications. Use of the transluminal extraction catheter, which cuts and aspirates atheroma and thrombus, has been advocated as a potential revascularization strategy for lesions with thrombus.
  
  
  METHODS
  Baseline patient characteristics, lesion morphology, immediate angiographic results, in-hospital complications and follow-up were prospectively entered into an interventional cardiology data base. The results of transluminal extraction coronary atherectomy in saphenous vein bypass grafts with angiographic thrombus were compared with results in similar grafts without angiographic thrombus.
  
  
  RESULTS
  Transluminal extraction coronary atherectomy was performed in 175 patients with 183 vein graft lesions, including 59 lesions (32%) with thrombus (Group 1) and 124 (68%) without thrombus (Group 2). Compared with lesions in Group 2, lesions in Group 1 were associated with a higher incidence of baseline total occlusion, diffuse disease and abnormal Thrombolysis in Myocardial Infarction (TIMI) grade flow (p < 0.05); more severe diameter stenosis at baseline, after atherectomy and after final angiography (p < 0.05); a lower rate of clinical success (69% vs. 88%, p < 0.01); and more angiographic and clinical complications, including no reflow (p < 0.05), vascular repair (p < 0.05) and Q wave myocardial infarction (p = 0.09).
  
  
  CONCLUSIONS
  In transluminal extraction coronary atherectomy of saphenous vein bypass grafts, the presence of thrombus is associated with more baseline lesion complexity, reduced clinical success and increased risk of no reflow, Q wave myocardial infarction and vascular repair.
authors.affiliation: Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
authors.forename: M
authors.initials: M
authors.lastname: Dooris
authors.forename: M
authors.initials: M
authors.lastname: Hoffmann
authors.forename: S
authors.initials: S
authors.lastname: Glazier
authors.forename: N
authors.initials: N
authors.lastname: Juran
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.forename: C L
authors.initials: CL
authors.lastname: Grines
authors.forename: G S
authors.initials: GS
authors.lastname: Pavlides
authors.forename: T
authors.initials: T
authors.lastname: Schreiber
authors.forename: W W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: R D
authors.initials: RD
authors.lastname: Safian
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary; D016022:Case-Control Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors