Procedural results and distal embolization after saphenous vein graft stenting and angioplasty for in-stent restenosis of grafts.
Saphenous vein graft (SVG) angioplasty is associated with frequent periprocedural complications due to distal embolization and a high risk of restenosis. The purpose of this single-center, retrospective study was to determine the distal embolization incidences and outcomes of stenting for SVG lesions and percutaneous angioplasty for in-stent restenosis of these SVGs. We studied 48 consecutive patients (mean age, 62 +/- 7 years, 92% men) who had prior CABG and underwent stent deployment to SVG lesions detected at our institution over a period of 4 years. Mean lesion length was 12.4 +/- 3.2 mm. The minimal lumen diameter increased from 0.7 +/- 0.3 mm to 3.2 +/- 0.4 mm after stenting. Distal embolization as no reflow/slow flow phenomenon occurred in 5 (10%) patients. Angiographic success was achieved in 98% of the patients. Procedural success was achieved in 96% of the patients. No reflow/slow flow phenomenon was observed, particularly in patients with acute coronary syndrome. During the follow-up, 11 patients (23%) had angiographic evidence of restenosis. Lesions were treated with balloon angioplasty and the minimal lumen diameter increased from 2.6 +/- 1.1 mm to 3.1 +/- 0.3 mm. The angiographic and procedural success rates were both 100%. There were no cases of "no" reflow/slow flow. Restenosis was particularly frequent in patients with diabetes mellitus, hypercholesterolemia, and acute coronary syndrome. Stent implantation in patients with de novo SVG lesions can be achieved with a high rate of angiographic and procedural success. The distal embolization risk is lower during angioplasty of in-stent restenosis lesions of SVGs compared to de novo SVG lesions.
Cicek
Dilek
D
Cardiology Department, Medical Faculty, Mersin University, Turkey.
Doven
Oben
O
Pekdemir
Hasan
H
Camsari
Ahmet
A
Akkus
Necdet M
NM
Cin
Gokhan V
GV
Parmaksiz
Tuncay
T
Katircibasi
Tuna
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004617:Embolism / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D015607:Stents; D016896:Treatment Outcome