title: A Randomized Trial of External Stenting for Saphenous Vein Grafts in Coronary Artery Bypass Grafting.
abstract: BACKGROUND
  External stents inhibit saphenous vein graft (SVG) intimal hyperplasia in animal studies. We investigated whether external stenting inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
  
  
  METHODS
  Thirty patients with multivessel disease undergoing coronary artery bypass graft surgery were enrolled. In addition to an internal mammary artery graft, each patient received one external stent to a single SVG randomly allocated to either the right or left coronary territories; and one or more nonstented SVG served as the control. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG intimal hyperplasia (mean area) assessed by intravascular ultrasonography at 1 year. Secondary endpoints were SVG failure, ectasia (>50% initial diameter), and overall uniformity as judged by Fitzgibbon classification.
  
  
  RESULTS
  One-year follow-up angiography was completed in 29 patients (96.6%). All internal mammary artery grafts were patent. Overall SVG failure rates did not differ significantly between the two groups (30% stented versus 28.2% nonstented SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43 SVGs, was significantly reduced in the stented group (4.37 ± 1.40 mm(2)) versus nonstented group (5.12 ± 1.35 mm(2), p = 0.04). In addition, stented SVGs demonstrated marginally significant improvement in lumen uniformity (p = 0.08) and less ectasia (6.7% versus 28.2%, p = 0.05). There was some evidence that ligation of side branches with metallic clips increased SVG failure in the stented group.
  
  
  CONCLUSIONS
  External stenting has the potential to improve SVG lumen uniformity and reduce diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
authors.affiliation: Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom. Electronic address: david.taggart@ouh.nhs.uk.
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.affiliation: Department of Cardiothoracic Surgery, Tal Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yanai
authors.initials: Y
authors.lastname: Ben Gal
authors.affiliation: Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors.forename: Belinda
authors.initials: B
authors.lastname: Lees
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Niket
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Webb
authors.affiliation: Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Rehman
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Desouza
authors.affiliation: Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Department of Cardiothoracic Surgery, Harefield Hospital, Middlesex, London, United Kingdom.
authors.forename: Fabio
authors.initials: F
authors.lastname: De Robertis
authors.affiliation: Department of Cardiology, Harefield Hospital, Middlesex, London, United Kingdom.
authors.forename: Miles
authors.initials: M
authors.lastname: Dalby
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Adrian
authors.initials: A
authors.lastname: Banning
authors.affiliation: Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Channon
authors.affiliation: Department of Cardiology, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: Vascular Graft Solutions Ltd, Tel Aviv, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Orion
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000503:physiopathology / Q000637:transplantation; D011446:Prospective Studies; D012086:Reoperation; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014654:Vascular Patency