Treatment of aortocoronary graft lesions with graft-stents.
OBJECTIVE
Previous controlled trials do not indicate a superiority of the polytetrafluoroethylene membrane-covered stent graft compared with a conventional stent with respect to acute results, restenosis, or clinical event rates. We evaluated the outcome of stenting aortocoronary bypass grafts with polytetrafluoroethylene-covered stent.


METHODS
The study included 64 patients who had 73 saphenous graft-stent implants. Clinical follow-up was obtained for a median of 6.2 months (1-9 months) for 54 patients.


RESULTS
The mean age of the grafts was 9.2+/-6 years (2-14 years). Procedural success was achieved in 72 of 73 lesions (98.6%). One patient having an anterior Q-wave myocardial infarction died on the second day of procedure. Four patients (6.2%) sustained distal embolization and no reflow. No reflow was overcome after intracoronary administration of nitroglycerine and verapamil in two cases. At follow-up, stable angina pectoris had developed in 10 patients (18%), unstable angina pectoris in two patients (3.7%), acute myocardial infarction in two patients (3.7%), and cardiac death in one patient (1.8%). A total of 45 patients had a coronary angiogram at 6 months of follow-up or earlier, and restenosis at the target site was detected in eight of 53 lesions (15%).


CONCLUSIONS
Saphenous graft lesions can be managed successfully with polytetrafluoroethylene-covered stents with acceptable long-term clinical outcome. Further and larger studies are needed to compare conventional stents, polytetrafluoroethylene-covered stents, drug eluting stents, and additional benefit of distal protection devices in these subgroups.
Boztosun
Bilal
B
Cardiology Department, Kosuyolu Heart and Research Centre, Medical Park Hospital, Istanbul, Turkey. bboztosun@hotmail.com
Gunes
Yilmaz
Y
Olcay
Ayhan
A
Esen
Ali Metin
AM
Esen
Ozlem Batukan
OB
Saglam
Mustafa
M
Kirma
Cevat
C
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D012086:Reoperation; D012107:Research Design; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014421:Turkey
D020099:Coated Materials, Biocompatible; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011138:Polytetrafluoroethylene