Palmaz-Schatz stenting for treatment of focal vein graft stenosis: immediate results and long-term outcome.
OBJECTIVE
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 stenting 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 restenosis (diameter stenosis > or = 50%) at 3- to 6-month follow-up was 17% (95% confidence interval 9% to 25%). By Kaplan-Meier estimates, however, the 2-year second revascularization rate was 49%, reflecting 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 excellent immediate and long-term angiographic results in this group of focally diseased, older saphenous vein grafts. Despite the high immediate success and very low (17%) angiographic restenosis rate at 6 months, approximately one half of these patients required further revascularization in the following 2 years, mainly because of disease progression at other sites.
Piana
R N
RN
Charles A. Dana Research Institute, Boston, Massachusetts.
Moscucci
M
M
Cohen
D J
DJ
Kugelmass
A D
AD
Senerchia
C
C
Kuntz
R E
RE
Baim
D S
DS
Carrozza
J P
JP
D000368:Aged; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome