title: Can direct stenting in selected saphenous vein graft lesions be considered an alternative to percutaneous intervention with a distal protection device?
abstract: BACKGROUND
  Distal embolization during percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) lesions is associated with a high rate of myonecrosis. Although direct stenting (DS) is feasible with less catheter manipulations, its ability to prevent distal embolization in SVG lesions compared with distal protection devices (DPD) is unknown.
  
  
  METHODS
  The study included 188 SVG lesions subjected to PCI, 101 patients with 101 lesions treated with DPD, and 87 patients with 87 lesions by DS without DPD. Major adverse cardiovascular events (MACE) in-hospital and at 30 days were compared.
  
  
  RESULTS
  Baseline characteristics were comparable, except for higher frequencies of unstable angina (53% vs. 67%, P = 0.045) and prior myocardial infarction (38% vs. 53%, P = 0.07) in the DS group. There was no difference in lesion type aside from more restenotic lesions in the DS group (7% vs. 16%, P = 0.047). Drug-eluting stent deployment was similar. Stent length in the DPD group (22.8 +/- 7.2 mm) was significantly longer than that in the DS group (17.6 +/- 8.0 mm, P < 0.001). Although maximum creatine kinase (CK)-MB value in the DPD group (2.5 +/- 5.8 ng/ml) was significantly larger than in the DS group (1.3 +/- 1.5 ng/ml, P = 0.039), the frequency of CK-MB rise >2 times the upper limit of normal did not differ (11% vs. 6%, P = 0.2). There were no differences in MACE rates in-hospital and at 30 days. By multivariate analysis, neither DPD nor DS was a significant predictor for maximum CK-MB value.
  
  
  CONCLUSIONS
  DS should be considered an alternative treatment to PCI with DPD for selected SVG lesions.
authors.affiliation: Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Probal
authors.initials: P
authors.lastname: Roy
authors.forename: Tina L Pinto
authors.initials: TL
authors.lastname: Slottow
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaneshige
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002318:Cardiovascular Diseases / Q000209:etiology; D017023:Coronary Angiography; D004617:Embolism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005374:Filtration / Q000295:instrumentation*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000637:transplantation*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency