title: Comparison of plaque sealing with paclitaxel-eluting stents versus medical therapy for the treatment of moderate nonsignificant saphenous vein graft lesions: the moderate vein graft lesion stenting with the taxus stent and intravascular ultrasound (VELETI) pilot trial.
abstract: BACKGROUND
  The presence of moderate saphenous vein graft (SVG) lesions is a major predictor of cardiac events late after coronary artery bypass grafting. We determined the effects of sealing moderate nonsignificant SVG lesions with paclitaxel-eluting stents (PES) on the prevention of SVG atherosclerosis progression.
  
  
  RESULTS
  Patients with at least 1 moderate SVG lesion (30% to 60% diameter stenosis) were randomized either to stenting the moderate SVG lesion with a PES (n=30, PES group) or to medical treatment alone (n=27, medical treatment group). Patients had an angiographic and intravascular ultrasound evaluation of the SVG at baseline and at 12-month follow-up. The primary end points were (1) the ultrasound SVG minimal lumen area at follow-up and (2) the changes in ultrasound atheroma volume in an angiographically nondiseased SVG segment. Mean time from coronary artery bypass grafting was 12+/-6 years, and mean low-density lipoprotein cholesterol level was 73+/-31 mg/dL. A total of 70 moderate SVG lesions (39+/-7% diameter stenosis) were evaluated. Significant disease progression occurred in the medical treatment group at the level of the moderate SVG lesion (decrease in minimal lumen area from 6.3+/-3.0 to 5.6+/-3.1 mm(2); P<0.001), leading to a severe flow-limiting lesion or SVG occlusion in 22% of the patients compared with none in the PES group (P=0.014). In the PES group, mean minimal lumen area increased (P<0.001) from 6.1+/-2.2 to 8.6+/-2.9 mm(2) at follow-up (P=0.001 compared with the medical treatment group at 12 months). There were no cases of restenosis or stent thrombosis. No significant atherosclerosis progression occurred at the nonstented SVG segments. At 12-month follow-up, the cumulative incidence of major adverse cardiac events related to the target SVG was 19% in the medical treatment group versus 3% in the PES group (P=0.091).
  
  
  CONCLUSIONS
  Stenting moderate nonsignificant lesions in old SVGs with PES was associated with a lower rate of SVG disease progression and a trend toward a lower incidence of major adverse cardiac events at 1-year follow-up compared with medical treatment alone, despite very low low-density lipoprotein cholesterol values. This pilot study supports further investigation into the role of plaque sealing in SVGs. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT002289835.
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725, Chemin Sainte-Foy, Québec, Canada. josep.rodes@criucpq.ulaval.ca
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.forename: Eric
authors.initials: E
authors.lastname: Larose
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Déry
authors.forename: Stéphane
authors.initials: S
authors.lastname: Rinfret
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Guy
authors.initials: G
authors.lastname: Proulx
authors.forename: Can M
authors.initials: CM
authors.lastname: Nguyen
authors.forename: Mélanie
authors.initials: M
authors.lastname: Côté
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Landcop
authors.forename: Jean-Rock
authors.initials: JR
authors.lastname: Boudreault
authors.forename: Jacques
authors.initials: J
authors.lastname: Rouleau
authors.forename: Louis
authors.initials: L
authors.lastname: Roy
authors.forename: Onil
authors.initials: O
authors.lastname: Gleeton
authors.forename: Gérald
authors.initials: G
authors.lastname: Barbeau
authors.forename: Bernard
authors.initials: B
authors.lastname: Noël
authors.forename: Javier
authors.initials: J
authors.lastname: Courtis
authors.forename: Gilles R
authors.initials: GR
authors.lastname: Dagenais
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Després
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy*; D008078:Cholesterol, LDL / Q000097:blood; D001026:Coronary Artery Bypass; D054855:Drug-Eluting Stents; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000494:pharmacology*; D010865:Pilot Projects; D011446:Prospective Studies; D050257:Tubulin Modulators / Q000494:pharmacology*
chemical_list: D008078:Cholesterol, LDL; D050257:Tubulin Modulators; D017239:Paclitaxel