Clinical presentation and angiographic characteristics of saphenous vein graft failure after stenting: insights from the SOS (stenting of saphenous vein grafts) trial.
OBJECTIVE
We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS).


BACKGROUND
The mode of SVG failure after stenting has been poorly characterized.


METHODS
The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients.


RESULTS
Binary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non-ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG.


CONCLUSIONS
SVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure.
Veteran Affairs North Texas Healthcare System, Dallas, Texas, USA.
Christopher
C
Lichtenwalter
James A
JA
de Lemos
Michele
M
Roesle
Owen
O
Obel
Elizabeth M
EM
Holper
Donald
D
Haagen
Bilal
B
Saeed
Jose Miguel
JM
Iturbe
Kendrick
K
Shunk
Joseph K
JK
Bissett
Rajesh
R
Sachdeva
Vassilios V
VV
Voudris
Panagiotis
P
Karyofillis
Biswajit
B
Kar
James
J
Rossen
Panayotis
P
Fasseas
Peter
P
Berger
Subhash
S
Banerjee
Emmanouil S
ES
Brilakis
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006115:Greece; D006801:Humans; D008670:Metals; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D017239:Paclitaxel / Q000008:administration & dosage; D011474:Prosthesis Design; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D016037:Single-Blind Method; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
D002317:Cardiovascular Agents; D008670:Metals; D017239:Paclitaxel