Percutaneous coronary intervention of or through saphenous vein grafts or internal mammary arteries: The impact of stents, adjunctive pharmacology, and multicomponent distal protection

Abstract

We hypothesized that the use of stents and aggressive adjunctive pharmacotherapies has been associated with lower rates of complicating myocardial infarction (MI) and improved long-term outcomes compared to either previous balloon-only percutaneous coronary intervention (PCI) or atheroablative intervention for lesions of or through saphenous vein grafts (SVGs) and/or internal mammary arteries (IMAs). PCI of SVG has been complicated by relatively high rates of procedural MI and less favorable long-term outcomes than native vessel PCI, stimulating the development and application of an array of technologies. This study was based on retrospective review of stent-era (1999-2004) 5-year experience of a single center with 95 SVG procedures in 85 patients and 20 IMA procedures in 20 patients. These cases were compared with the previously published experience of one of the operators during the balloon-only period and literature review of the application of multiple technologies to SVG intervention, as well as consideration of the reoperation alternative. There was one in-hospital death each in the SVG cohort (1%) and in the IMA cohort (5%). There were SIX procedural MIs (6%), defined by total CK > normal, and 19 procedural MIs (20%) based on troponin-I > 1.0. Follow-up has been from 4 months to 5 years (average, 2.5 years), with 91% survival and one late CABG in the IMA group. SVG PCI with stents and adjunctive pharmacotherapies is associated with relatively low rates of procedural MI and favorable long-term outcomes.

Successful Percutaneous Intervention for Ostial Stenosis of Left Internal Mammary Arterial Graft

“…Therefore, we preferred the femoral approach for LIMA intervention and for the subsequent coronary intervention. Angioplasty and stenting of the distal anastomotic lesions provide adequate results in LIMA grafts; however, data regarding angioplasty and stenting of the ostial lesions in LIMA grafts are insufficient (13)(14)(15) . In addition, published data on the use of drug-eluting stents in the ostial lesions of the LIMA are also insufficient.…”