Direct Stenting in Saphenous Vein Grafts. Immediate and Long-Term Results

Lozano, Íñigo; López-Palop, Ramón; Pinar, Eduardo; Saura, Daniel; Fuertes, Jorge; Rondán, Juan; Suárez, Emma; Valdés, Mariano; Morı́s, César

doi:10.1016/s1885-5857(06)60488-x

Cited by 4 publications

(5 citation statements)

References 56 publications

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“…Median follow-up time was 36.1 months. No differences were found in long-term mortality between the two groups (Lozano et al, 2005).…”

Section: Direct Stenting In Saphenous Vein Graftsmentioning

confidence: 71%

“…Besides, the results of bare metal stents in saphenous vein grafts are less favourable than those in native vessels, with restenosis rates exceeding 30% (Savage et al, 1997;Silber et al, 2005). In fact some authors recommend carrying out percutaneous coronary intervention in native vessels whenever possible even when there is complete obstruction or to consider the possibility of new revascularisation surgery rather than percutaneous saphenous vein graft intervention (Lozano et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…The reason for this late pattern according to some authors, could be the larger reference diameter, which means more time would be required to reach a minimum luminal diameter small enough to yield clinical findings. (Hong et al, 2000;Lozano et al, 2005) …”

Section: Restenosis After Successful Balloon Angioplasty Of Saphenousmentioning

confidence: 99%

“…Thus, one of the greatest restrictions to stent implantation with predilatation is the risk of distal embolisation, with a high incidence of peri-procedural myocardial infarction (Lozano et al, 2005).…”

Section: Direct Stenting In Saphenous Vein Graftsmentioning

confidence: 99%

See 3 more Smart Citations

Percutaneous Intervention Post Coronary Artery Graft Surgery in Patients with Saphenous Vein Graft Disease – State of the Art

Oqueli¹

2012

Coronary Interventions

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“…Median follow-up time was 36.1 months. No differences were found in long-term mortality between the two groups (Lozano et al, 2005).…”

Section: Direct Stenting In Saphenous Vein Graftsmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Restenosis After Successful Balloon Angioplasty Of Saphenousmentioning

confidence: 99%

Section: Direct Stenting In Saphenous Vein Graftsmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous Intervention Post Coronary Artery Graft Surgery in Patients with Saphenous Vein Graft Disease – State of the Art

Oqueli¹

2012

Coronary Interventions

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“…The hypothesis was that the stent would act as scaffold to trap the friable tissue of the plaque before balloon dilatation and reduce its fragmentation. Leborgne et al 24 and Lozano et al 25 proposed that direct stenting should be preferred whenever feasible in SVG stenting especially when a distal protection device cannot be used as direct stenting scored in terms of distal embolization. The present study failed to show that direct stenting scores over conventional stenting in terms of preventing distal embolization in SVG lesions.…”

Section: Discussionmentioning

confidence: 99%

Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions

2018

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Distal embolization is the detrimental factor in SVG intervention. There is no specific treatment for it except prevention. Guidelines have endorsed the use of embolic protection devices; however, their use is not without complications, and increases the procedural time and cost for the patient. The objective of this study is to analyze the procedural results and immediate outcome in de novo SVG stenting. A retrospective observational study of patients who have undergone SVG-percutaneous coronary intervention at our institute. Baseline clinical, demographic data, intervention details, and in-hospital events are analyzed. Statistical analysis was done using Mini tab version 17. Chi-square testing, odds ratio, and 95% confidence intervals were calculated. The study population included 96 lesions in 80 patients. Average age of the graft was 8.2 ± 4 years. Embolic protection devices were used only in 10%. Angiographic and clinical success was seen in 92.5%. Distal embolization was seen in 7.5%. Drug-eluting stent and shorter stents were associated with lesser distal embolization. Stent length (> 20 mm) proved to be an independent predictor of distal embolization. There was no correlation between distal embolization and age of patient, sex, hypertension, diabetes, and smoking, left ventricular function, age of graft, direct stenting, use of embolic device, and glycoprotein 2b/3a inhibitors. De novo SVG lesions can be stented with a high rate of angiographic and procedural success. Stent length is the only independent predictor of distal embolization. SVG interventions can be safely done in the absence of embolic protection devices irrespective of the graft age.

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Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention

Latif

Uyeda

Edson

et al. 2020

Circ: Cardiovascular Interventions

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Background: Direct stenting without pre-dilation or post-dilation has been advocated for saphenous vein graft percutaneous coronary intervention to decrease the incidence of distal embolization, periprocedural myocardial infarction, and target lesion revascularization. Methods: We performed a post hoc analysis of patients enrolled in the DIVA (Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Angioplasty; NCT 01121224) prospective, double-blind, randomized controlled trial. Patients were stratified into stent-only and balloon-stent groups. Primary end point was 12-month incidence of target vessel failure (defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization). Secondary end points included all-cause death, stent thrombosis, myocardial infarction, and target lesion revascularization during follow-up. Results: Of the 575 patients included in this substudy, 185 (32%) patients underwent stent-only percutaneous coronary intervention. Patients in the stent-only versus balloon-stent group had similar baseline characteristics and similar incidence of target vessel failure at 12-months (15% versus 19%; hazard ratio, 1.34 [95% CI, 0.86–2.08]; P =0.19). During long-term follow-up (median of 2.7 years), the incidence of definite stent thrombosis (1% versus 5%; hazard ratio, 9.20 [95% CI, 1.23–68.92]; P =0.0085), the composite of definite or probable stent thrombosis (5% versus 11%; hazard ratio, 2.52 [95% CI, 1.23–5.18]; P =0.009), and target vessel myocardial infarction (8% versus 14%; hazard ratio, 1.92 [95% CI, 1.08–3.40]; P =0.023) was lower in the stent-only group. Multivariable analysis showed that a higher number of years since coronary artery bypass grafting and >1 target saphenous vein graft lesions were associated with increased target vessel failure during entire follow-up, while preintervention Thrombolysis in Myocardial Infarction-3 flow was protective. Conclusions: In patients undergoing percutaneous coronary intervention of de novo saphenous vein graft lesions, there was no difference in target vessel failure at 12 months and long-term follow-up in the stent-only versus the balloon-stent group; however, the incidence of stent thrombosis was lower in the stent-only group, as was target vessel myocardial infarction. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT 01121224.

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Direct Stenting in Saphenous Vein Grafts. Immediate and Long-Term Results

Cited by 4 publications

References 56 publications

Percutaneous Intervention Post Coronary Artery Graft Surgery in Patients with Saphenous Vein Graft Disease – State of the Art

Percutaneous Intervention Post Coronary Artery Graft Surgery in Patients with Saphenous Vein Graft Disease – State of the Art

Procedural Results and Immediate Outcomes following De Novo Saphenous Venous Graft Interventions

Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention

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