Long-term clinical results after stent implantation in old obstructed saphenous vein grafts.

STUDY OBJECTIVE: To assess the long-term clinical outcome of treating patients with coronary artery disease and obstructed saphenous vein grafts (SVGs) with stents deployed by oversized balloon catheters. DESIGN: The study included 89 of 92 consecutive patients who had 121 SVG stent implants (average, 1.4 stents per patient). We aimed at achieving a negative stenosis using oversized balloons to achieve a catheter to artery ratio of 1.1:1, and a 100% follow-up at 24+/-14 months (range, 0 to 54 months) was achieved. PATIENTS: As 3 of 92 patients died during hospital admission, the study follow-up population consisted of 89 of 92 patients (mean age, 67+/-10 years). The age of the SVGs was 10+/-4 years. RESULTS: We implanted 118 Palmaz-Schatz and 3 Gianturco-Roubin stents. Procedural success was achieved in 87 of 92 patients (94.5%; < 50% stenosis, and no death, Q-wave acute myocardial infarction, or coronary artery bypass graft [CABG]). Mean SVG stenosis diameter was reduced from 80+/-13% to -11+/-12% (p<0.001) and mean luminal diameter increased from 0.6+/-0.5 mm to 3.3+/-0.8 mm (p<0.001). At follow-up, angina pectoris had developed in 42 of 89 patients (47%), acute myocardial infarction in 12 of 89 patients (14%), reperformed CABG in 12 of 89 patients (14%), cardiac death in 10 of 89 patients (11%), and unrelated death in 6 of 89 patients (7%). Coronary angiography was performed in 37 of 89 patients (42%), with restenosis in 16 of 37 patients (43%) and disease progression at other sites in 11 of 37 patients (30%). Only 25 of 89 patients (28%) experienced event-free survival at follow-up. CONCLUSIONS: Despite high procedural success and excellent angiographic results with oversized balloon catheters, the long-term clinical outcome of SVG stent implantation is suboptimal.

Immediate and long-term results comparing coronary versus biliary tubular-slotted stents to treat old obstructed saphenous vein grafts.

Stenting of old obstructed saphenous vein grafts improves immediate angiographic results and long-term clinical outcome compared to standard balloon angioplasty. Comparison of results and long-term clinical outcome between different types of stents in the treatment of vein graft disease is scarce. The authors studied two matched groups of 33 patients each, receiving either coronary or biliary tubular-slotted stents in old vein graft lesions to compare immediate results and long-term clinical outcome. Patients in the two groups were matched for age and left ventricular function. Baseline angiographic characteristics, the minimal luminal diameter (MLD) (0.68 +/- 0.56 mm vs 0.61 +/- 0.51 mm, p = 0.9), and diameter stenosis (DS) (81 +/- 14% vs 82 +/- 15%) were similar between the groups. After stenting, the MLD (3.15 +/- 0.65 mm vs 3.37 +/- 0.63 mm, p = 0.9) and residual stenosis (-7 +/- 19% vs -11 +/- 21%) were also similar. The in-hospital major complications (myocardial infarction and death) (one vs eight, p = 0.01) and the combination of major and minor (bleeding and vascular) complications (eight vs 17, p = 0.02) were higher in the biliary stent group. At long-term follow-up, both groups of patients had high but comparable rates of major cardiovascular events (39% vs 45%, p = 0.62). Kaplan-Meier event-free survival analysis did not show any statistically significant difference in event-free survival (log-rank statistic 0.98). The authors conclude that patients receiving biliary stents had higher rates of immediate minor and major complications, but at long-term follow up, major cardiovascular event rates were comparable between the two groups of patients.

Results of saphenous vein graft stent implantation: single center results from use of oversized balloon catheters.

The results and complications of a single-center experience of stent implantation in old saphenous vein grafts (SVGs) need to be defined. The authors studied their initial consecutive 92 patients (125 stents, 1.4 stents/per patient) with a mean age of 67+/-9 years. The patients' mean saphenous vein graft (SVG) age was 10+/-4 years, and the mean left ventricular ejection fraction was 46%+/-15. Patient population included unstable angina (65%), stable angina (10%), myocardial infarction (21%), and silent ischemia (4%). The authors implanted 122 Palmaz-Schatz/biliary and three Gianturco-Roubin stents. They aimed at a balloon-artery ratio of 1.1/1.0. Procedural success, defined as stent deployment with <50% stenosis without death/Q-wave myocardial infarction/coronary artery bypass grafting (MI/CABG) was 95%. The mean luminal diameter (MLD) increased from 0.6+/-0.5 to 3.3+/-0.8 mm (p<0.001) and mean SVG stenosis diameter was decreased from 80%+/-14 to -10%+/-11 (p<0.001). Angiographic SVG lesions exhibited thrombus (17%), ulceration (38%), and plaque rupture (28%). Sixty-two patients were treated with warfarin and aspirin and 30 with ticlid and aspirin. Complications included death in three patients (3.3%) who sustained subacute stent thrombosis, and two of three had Q-wave MI. Distal embolization occurred in seven patients (8%); six of seven sustained a non Q-wave acute myocardial infarction (AMI); and one of seven a Q-wave MI. Eight (9%) patients had major groin hematoma, two had pseudoaneurysm (2.2%), one had arteriovenous (A-V) fistula (1.1%), two had vascular surgery (2.2%), nine had blood transfusion (9.8%), and three had stent migration (3.3%). Single-center experience with stents in SVGs indicates a highly successful procedural and angiographic immediate result. However, it was complicated by significant risk of non Q-wave MI due to distal coronary embolization which may affect prognosis.

Pulmonary artery pseudoaneurysm after percutaneous transluminal angioplasty in a pediatric patient.

We report a case of a 4-year-old boy with tetralogy of Fallot, pulmonary atresia, and hypoplastic pulmonary arteries who presented with mild hemoptysis and upper respiratory infection 3 weeks following percutaneous transluminal angioplasty for pulmonary artery stenosis. While pneumonia was initially suggested on early plain radiographs of the chest, a large pseudoaneurysm of a right lower lobe pulmonary artery branch was subsequently diagnosed with CT and angiography.