title: In-hospital and long-term results of stent deployment compared with balloon angioplasty for treatment of narrowing at the saphenous vein graft distal anastomosis site.
abstract: Disease at the distal anastomosis site of saphenous vein grafts (SVGs) has been successfully treated with balloon angioplasty, with a lower restenosis rate than at sites of the aortoostial or proximal portion of the SVG. The role of stents for these lesions has not been well defined. To compare the in-hospital and long-term outcome of patients who underwent treatment at this site by either balloon angioplasty or tubular stent implantation, we studied 182 consecutive patients who underwent balloon angioplasty and 77 patients who underwent stenting between January 1994 and August 1997. Baseline clinical characteristics for both groups were similar. Angiographically, SVG stenoses treated with stents were older, longer in lesion length, and more restenotic. The in-hospital outcome was similar for both groups, with 98% procedural success rates and 1% major ischemic complications. Long-term follow-up was obtained for 93% of the patients, for an average of 17 +/- 14 months. The mortality rates were similar for patients who underwent balloon angioplasty and stenting (11.6% vs 13%, p = NS). The Q-wave myocardial infarction rates were also similar (1% vs 0%, p = NS). There was a trend toward a higher rate of target lesion revascularization in the balloon angioplasty group (25% vs 14%, p = 0.058). We conclude that percutaneous revascularization of the SVG distal anastomosis site by either balloon angioplasty or stenting can be performed with a high rate of procedural success and favorable in-hospital and long-term outcomes. Stent deployment may further improve the long-term outcome of these patients by reducing the need for repeat revascularization.
authors.affiliation: Cardiac Catheterization Laboratory and the Cardiovascular Research Foundation, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: L
authors.initials: L
authors.lastname: Gruberg
authors.forename: M K
authors.initials: MK
authors.lastname: Hong
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: G S
authors.initials: GS
authors.lastname: Mintz
authors.forename: R
authors.initials: R
authors.lastname: Kornowski
authors.forename: A J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: K M
authors.initials: KM
authors.lastname: Kent
authors.forename: A D
authors.initials: AD
authors.lastname: Pichard
authors.forename: L F
authors.initials: LF
authors.lastname: Satler
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: H
authors.initials: H
authors.lastname: Wu
authors.forename: G W
authors.initials: GW
authors.lastname: Stone
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D015996:Survival Rate; D014680:Veins / Q000637:transplantation*