A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis

Abstract

Our meta-analysis suggests DES use to be safe in SVG PCI and associated with reduced mortality and MACE rates with reductions in revascularization also observed.

Reinterventions for stent restenosis in patients treated for atherosclerotic mesenteric artery disease

“…16 Drug-eluting stents (DES) may prove useful by blocking cellular proliferation and reducing intimal hyperplasia in the treated vessel. The favorable results of DES for native coronary 17 and renal 15 artery stenosis encouraged its use to treat restenosis, but the stent diameters are small (Ͻ5 mm) for the mesenteric arteries. While several authors report low incidences of recurrent stenosis after treatment of coronary in-stent restenosis, Stone and associates found no benefit with use of DES to treat renal in-stent restenoses when compared with bare metal stents.…”

Comparison of safety and efficacy of paclitaxel-eluting stents with durable versus biodegradable polymer implanted in saphenous vein graft lesions. Nine-month angiographic and intravascular ultrasound follow-up

“…Percutaneous coronary intervention (PCI) with stent implantation is the most often utilized revascularization strategy also for saphenous vein graft stenosis. However, although up to 10% of PCI procedures are performed in SVGs this lesion subset is underrepresented in the DES trials [6][7][8]. The 3-year follow-up of the RRISC study in which patients with SVG stenosis were randomized to DES versus BMS showed significantly higher mortality in the DES group [9].…”

Long‐term outcome following percutaneous coronary intervention with drug‐eluting stents compared with bare‐metal stents in saphenous vein graft lesions: From Western Denmark heart registry

“…We did not find any difference in mortality among DES‐ and BMS‐treated patients. Although the power of the current study is limited in comparison to 2 meta‐analysis where DES were associated with a lower mortality rate. However, as the inclusion criteria—especially in the early trials in the pooled analysis—might have had more restricted inclusion criteria (related to lesions and comorbidity) and thus the patients in the meta‐analysis do not represent patients with vein graft lesion in daily clinical practice which may affects the generalizability of the results.…”

“…However, the stent failure and TLR rates were numerically higher in BMS‐treated vein grafts compared to DES‐treated vein grafts after 1 year, but this numerically higher rate in BMS was attenuated after 3 years. Several studies and a meta‐analysis have documented a short term benefit favoring DES in reducing risk of TLR, although registries with longer follow‐up have shown less consistent benefit . This may be related to progression of disease in nonintervened segments proximal and distal to the stent.…”

“…The benefits of DES in relation to PCI of SVG lesions has, however, not been clearly established. The safety and efficacy of DES versus BMS in SVG remains uncertain due to contradictory reports . Atherosclerotic disease in SVG has several peculiarities that make it difficult to extrapolate outcomes of the use of DES as compared to BMS, from outcomes observed in native coronary arteries .…”