Interventional cardiologyEffect of direct stenting on clinical outcome in patients treated with percutaneous coronary intervention on saphenous vein graft
Section snippets
Study population
Between January 1994 and May 2001, 1650 consecutive patients with prior coronary artery bypass surgery underwent percutaneous angioplasty for narrowing SVG lesions at the Washington Hospital Center. Patients with total occlusion, acute MI, or restenosis were excluded. In this cohort, we identified 170 patients with 229 lesions that were treated with DS and 357 patients with 443 lesions that were treated with CS (without debulking before stenting). The entire patient cohort was treated without
Baseline demographics
The clinical characteristics of the patients are displayed in Table I. The patient group represents a typical patient cohort undergoing SVG stenting, with a high prevalence of unstable angina (74.4%). The average graft age was 8.77 ± 4.8 years. There was a high prevalence of diabetes (34.4%) and insulin-dependent diabetes was present in 14.4% of the patients. Patient demographic data were similar between the 2 groups except for a trend for more hypertension in the DS patients (73.5% vs 66.4%, P
Discussion
Our study shows that PCI with DS of SVG lesions is associated with a high clinical success rate and significantly decreases both the rates of high CK-elevation postangioplasty and the major cardiac events at 1-year follow-up when compared to PCI with predilatation.
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Cited by (64)
Saphenous Vein Graft Intervention
2022, Interventional Cardiology ClinicsCitation Excerpt :Direct stenting of SVG lesions may trap debris against the vessel wall and cause less SVG wall trauma. In a study of 527 consecutive patients undergoing SVG intervention, direct stenting was associated with lower CK-MB release periprocedurally and lower TLR at 1 year compared with a conventional stenting.35 A posthoc analysis of patients in the DIVA trial comparing direct stenting (without predilation or postdilation) with “balloon stent” strategy demonstrated a lower incidence of definite stent thrombosis (1% vs 5%, P = .009), definite/probable stent thrombosis (5% vs 11%, P = .009), and target vessel MI (8% vs 14%, P = .023) in the direct stenting group at long-term follow-up (median 2.7 years).36
Revascularization of complex coronary lesions: The importance of vessel and plaque preparation strategies
2022, Debulking in Cardiovascular Interventions and Revascularization Strategies: Between a Rock and the HeartUpdate on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery
2019, JACC: Cardiovascular InterventionsCitation Excerpt :The only strategy that has been tested in randomized controlled trials is use of embolic protection devices. Other strategies include vasodilator administration, direct stenting (22), and use of undersized stents (23). Nicardipine is often preferred due to prolonged duration of action and less hypotensive effect and is often administered both before and after PCI.
Is It Still Worth the Pain to "drain" Stenosed Saphenous Veins? Appraising Native Coronary Artery Versus Bypass Graft Percutaneous Coronary Interventions
2016, JACC: Cardiovascular InterventionsSaphenous Vein Graft Interventions
2016, Interventional Cardiology ClinicsCitation Excerpt :Predilation, although frequently used as a lesion preparation strategy in non-SVG interventions, might be suboptimal in this setting. In a registry of patients who underwent SVG intervention, direct stenting was associated with a marked reduction in postprocedural myocardial infarction.24 The ISAR-CABG (Drug-eluting versus bare-metal stents in saphenous vein graft lesions) trial, which was the largest randomized trial comparing bare-metal stents (BMS) to DES in SVG intervention, reported a significantly lower target vessel revascularization rate in the DES group (7% vs 13%, P = .01).25