Saphenous Vein Graft Lesions Research Articles

Prevalence and outcomes of intermediate saphenous vein graft lesions: Findings from the stenting of saphenous vein grafts randomized-controlled trial

We sought to examine the prevalence and progression rate of intermediate saphenous vein graft (SVG) lesions in the Stenting Of Saphenous vein grafts (SOS) trial. The baseline and follow-up angiograms of 80 patients participating in the SOS trial were analyzed to determine the prevalence of intermediate (30-60% angiographic diameter stenosis) SVG lesions and their progression rate. At least one intermediate SVG lesion was present in 31 of 143 (22%) SVGs in 27 of 80 (34%) patients. Most intermediate lesions were present in the SOS stented SVGs (20 grafts in 19 patients). During a median follow-up of 35 months, angiographic follow-up was available for 28 grafts in 25 patients. Progression (defined as percent diameter stenosis ≥ 70% but <100% at follow-up angiography) was seen in 11 of 28 SVGs (39%) in 11 of 25 patients (44%). Progression rate at 12, 24 and 36 months was 28% and 47% and 84%, respectively. Seven of 11 patients (64%) with intermediate SVG lesion progression presented with an acute coronary syndrome and 8 (73%) underwent PCI. Four of the 28 grafts with intermediate lesions at baseline were 100% occluded at follow-up; all of those SVGs had received a stent in another location in the SVG as part of the SOS trial. Intermediate SVG lesions are common in patients undergoing SVG stenting, have high rates of progression and frequently present with an acute coronary syndrome. Further study of pharmacologic and mechanical treatments to prevent progression of these lesions is needed.

Two-Year Follow-Up of Outcomes of Second-Generation Everolimus-Eluting Stents Versus First-Generation Drug-Eluting Stents for Stenosis of Saphenous Vein Grafts Used as Aortocoronary Conduits

Second-generation everolimus-eluting stents (EESs) have demonstrated superiority in efficacy and safety compared with first-generation drug-eluting stents (DESs) in the treatment of native coronary artery lesions. The present study evaluated and compared the safety and efficacy of EESs and first-generation DESs in saphenous vein graft lesions. The EES group consisted of 88 patients with 96 lesions, and the first-generation DES group consisted of 243 patients with 317 lesions (sirolimus-eluting stents, n = 212; paclitaxel-eluting stents, n = 105). The end points included target lesion revascularization, target vessel revascularization, major adverse cardiovascular events (composite of all-cause death, myocardial infarction, and target vessel revascularization), and definite stent thrombosis at 2 years. The groups had similar baseline characteristics and graft ages (128.1 ± 77.5 vs 132.4 ± 90.8 months, p = 0.686). The EES group had more type C lesions and less embolic protection device use. The peak postprocedure values of creatinine kinase-MB and troponin I were similar between the 2 groups. Overall, major adverse cardiovascular events occurred in 18.2% of EES patients and 35.0% of first-generation DES patients (p = 0.003), mainly driven by a lower target vessel revascularization rate (6.8% vs 24.5%, p <0.001). The target lesion revascularization rate was lower in the EES group (1.1% vs 11.6%, p = 0.005). Stent thrombosis was low and similar between the 2 groups (0% vs 0.8%, p = 1.000). On multivariate analysis, the type of DES implanted and graft age were the only independent predictors of major adverse cardiovascular events. In conclusion, the superiority of EESs compared with first-generation DESs shown in native artery lesions has been extended to saphenous vein graft lesions and should be considered as the DES of choice for this lesion type.

Incidence, Predictors, and Clinical Impact of Tissue Prolapse After Stent Implantation for Saphenous Vein Graft Disease: Intravascular Ultrasound Study

The incidence and predictors of tissue prolapse (TP) and its clinical impact after stent implantation for saphenous vein graft (SVG) lesions are unknown. The aim of the this study was to evaluate the incidence and predictors of TP and the association of TP and clinical outcomes after stent implantation for SVG lesions.

Long-term follow-up after percutaneous coronary intervention with polytetrafl uoroethylene-covered Symbiot™ stents compared to bare metal stents, with and without FilterWire™ embolic protection, in diseased saphenous vein grafts

Objectives The long-term clinical outcome of covered stents in the percutaneous treatment of diseased saphenous vein graft (SVG) has been disappointing. The single self-expanding polytetrafl uoroethylene (PTFE)-covered Symbiot stent with a unique profi le may present advantages that translate into superior long-term clinical outcomes. This study evaluated the safety, eff ectiveness and clinical outcome of the SymbiotTM covered stent system (Boston Scientifi c, Natick, Mass.) and FilterWireTM EX (Boston Scientifi c, Natick, Mass.) versus bare metal stents (BMS) in SVG intervention.Methods and results Between January 2003 and August 2005, 90 patients with degenerative SVG lesions were prospectively randomized at 6 study sites to Symbiot implantation (n = 30), BMS with FilterWire as embolic protection device (EPD, n = 30), or BMS without EPD (control group, n = 30). The primary end point was reduction in peri-procedural cardiac enzyme rise. The major secondary end points were in-hospital, 6-month and long-term target vessel failure rates, defi ned as the cumulative of death, myocardial infarction and clinically driven target lesion revascularization. There was no signifi cant reduction in median [IQR] post-procedural troponin-I rise in the Symbiot group compared to the FilterWire or the control group (0.08 [0-1.40] μ g/l; 0.06 [0-0.28] μg/l; and 0.04 [0-0.31] μg/l, P= 0.58). At 7.4 ± 1.3 (mean ± SD) years, there were numerically less deaths in the Symbiot group, although this did not reach statistical signifi cance (P= 0.20). There was no signifi cant diff erence in TVF-free survival between the treatment groups (P= 0.98).Conclusion This study failed to show a procedural or long-term clinical advantage for the Symbiot PTFE-covered stent in the treatment of degenerated SVG.

The state of the excimer laser for coronary intervention in the drug-eluting stent era

This study aims to determine how excimer laser coronary atherectomy (ELCA) performs in the drug-eluting stent (DES) era. For more than 20 years, ELCA has been used for coronary intervention. With developments in the coronary intervention field, the role of ELCA is in question. The study includes 119 patients with 124 lesions who underwent percutaneous coronary intervention (PCI) with ELCA in our institution from January 2004 to May 2011. The main indications for ELCA use were saphenous vein graft (SVG) (45 lesions), acute myocardial infarction (AMI) (7 lesions), chronic total occlusion (CTO) (32 lesions), in-stent restenosis (ISR) (15 lesions), and calcified de-novo lesions (25 lesions). High success rates were recorded for the SVG, AMI, CTO, ISR, and calcified lesion indications (91.1%, 85.7%, 93.8%, 86.7%, and 80%; respectively). ELCA related complications were reported in 10 patients (8%); four dissections, three no-reflow phenomena, two perforations, and one thrombus formation. ELCA is an alternative solution with acceptable performance in the treatment of complex coronary lesions not ideally suitable for balloon angioplasty.

Very Late Evaluation of the Use of Drug-Eluting Stents for the Treatment of Patients with Saphenous Vein Graft Lesions: One-Decade Experience of the DESIRE Registry

Percutaneous coronary intervention (PCI) in saphenous vein grafts remains a challenge for interventional cardiology, due to acute complications and the lack of data on the late efficacy of drug-eluting stents (DESs). Between May 2002 and January 2013, patients undergoing PCI with DES at Hospital do Coração were included in the DESIRE Registry. We evaluated the results of patients undergoing PCI in saphenous vein grafts (group 1), who were compared to those undergoing PCI in native vessels (group 2.) Of a total of 4,655 patients, 311 were included in group 1 and 4,344 in group 2. Group 1 included older patients (68.4 ± 9.7 years vs. 64 ± 11.2 years; P < 0.01), more frequently male (87.1% vs. 76.7%; P < 0.01) with a higher incidence of comorbidities. Unstable angina was the most frequent clínical presentation in this group. Group 1 patients received large caliber stents (3.18 ± 1.11 mm vs. 2.86 ± 0.43 mm; P < 0.01) and were less frequently submitted to pre-dilation (36.3% vs. 50.7%; P < 0.01) and post-dilation (38.3% vs. 58.4%; P < 0.01). They had a higher incidence of non-fatal acute myocardial infarction during hospitalization (11.3% vs. 4.1%; P < 0.01) and late major adverse cardiovascular events (32.8% vs. 13.9%; P < 0.01), at the expense of cardiac death (7.7% vs. 3.2%; P = 0.02) and target-lesion revascularization (9% vs. 4.3%; P < 0.01). Definitive stent thrombosis was more frequent in group 1 (3.5% vs. 1%; P < 0.01). Despite the unquestionable benefit of DESs in the late outcomes of PCI in complex patients, the treatment of patients with saphenous vein graft lesions remains a challenge, with less favorable acute and late results than in patients with native vessel lesions. Avaliação Muito Tardia do Uso de Stents Farmacológicos para Tratamento de Pacientes com Lesões em Enxertos de Veia Safena: Experiência de uma Década do Registro DESIRE A intervenção coronária percutânea (ICP) em pontes de safena ainda representa um desafio à Cardiologia intervencionista, pelas complicações agudas e pela escassez de dados referentes à efetividade tardia dos stents farmacológicos (SFs). Entre maio de 2002 e janeiro de 2013, pacientes submetidos à ICP com SF no Hospital do Coração foram incluídos no Registro DESIRE. Avaliamos os resultados de pacientes submetidos à ICP em pontes de safena (grupo 1),que foram comparados aos submetidos a ICP em vasos nativos (grupo 2). De um total de 4.655 pacientes, 311 foram incluidos no grupo 1 e 4.344, no grupo 2. O grupo 1 contou com pacientes mais idosos (68,4 ± 9,7 anos vs. 64 ± 11,2 anos; P < 0,01), com mais pacientes do sexo masculino (87,1% vs. 76,7%; P < 0,01) e com maior incidência de comorbidades. Angina instável foi a apresentação clínica mais frequente nesse grupo. Pacientes do grupo 1 receberam stents de maior calibre (3,18 ± 1,11 mm vs. 2,86 ± 0,43 mm; P < 0,01) e foram submetidos menos frequentemente a pré-dilatação (36,3% vs. 50,7%; P < 0,01) e a pós-dilatação (38,3% vs. 58,4%; P < 0,01). Apresentaram mais infarto agudo do miocàrdio não-fatal na fase hospitalar (11,3% vs. 4,1%; P < 0,01) e mais eventos cardiovasculares adversos maiores na fase tardia (32,8% vs. 13,9%; P < 0,01), à custa de óbito cardíaco (7,7% vs. 3,2%; P = 0,02) e de revascularizaçâo da lesäo-alvo (9% vs. 4,3%; P < 0,01). Trombose definitiva do stent foi mais frequente no grupo 1 (3,5% vs. 1%; P < 0,01).

Very Late Evaluation of the Use of Drug-Eluting Stents for the Treatment of Patients with Saphenous Vein Graft Lesions: One-Decade Experience of the DESIRE Registry

Very Late Evaluation of the Use of Drug-Eluting Stents for the Treatment of Patients with Saphenous Vein Graft Lesions: One-Decade Experience of the DESIRE Registry

One‐Year Outcome of Small‐Vessel Disease Treated with Sirolimus‐Eluting Stents: A Subgroup Analysis of the e‐SELECT Registry

To investigate the characteristics and one-year outcomes following sirolimus-eluting CYPHER Select Plus stent (SES) implantation in small (SmVD) and non-small vessel disease (NSmVD) in the international e-SELECT registry. Large-scale registry data are lacking on DES outcomes in SmVD treatment. There were 4,700 SmVD (at least one vessel with estimated reference vessel diameter [RVD] < 2.5 mm, excluding 283 patients with unknown RVD vessels) and 10,139 NSmVD only patients. The SmVD population was older, with more women, diabetics, and vessels treated, higher mean Charlson Comorbidity Index score (CCI), shorter lesions, and less STEMI presentation. The 1-year stent thrombosis (ST) rate (primary end-point), was significantly higher (1.3% vs. 0.7%) in SmVD versus NSmVD, mainly driven by early events. One-year major adverse cardiac event (MACE), myocardial infarction (MI), and clinically indicated target-lesion revascularization (TLR) rates were significantly higher in SmVD although death and major bleeding rates were similar in both groups. Complication rates were similar between pure (3,188 patients; only RVD < 2.5 mm) and mixed (1,795 patients; some RVD < 2.5 mm or unknown RVD) SmVD. Multivariate predictors for 1-year MACE in SmVD included saphenous vein graft or bifurcation lesions, major bleeding, any antiplatelet therapy discontinuation within 1 month, age, number of stents implanted, CCI, acute coronary syndrome, and insulin-dependent diabetes mellitus. SES implantation for SmVD occurs more frequently in women, diabetics, and those with multivessel disease and comorbidities. One-year ST, MACE, MI, and clinically indicated TLR rates are higher, although low overall, in SmVD or mixed SmVD patients while death rates are similar to NSmVD.

TCT-654 Comparison in the 5-year Outcome of Pericardium and Polytetrafluoroethylene-Covered Stents for Saphenous Vein Graft Lesions

Percutaneous intervention (PCI) for degenerated saphenous vein graft (SVG) lesions are well known for high rates of no-reflow, restenosis (ISR) and stent thrombosis. Covered stents have been tried in an aim to trap the debris to minimize no-reflow and ISR. Two types of covered stents have been used

TCT-673 Drug-eluting stents versus bare metal stents for saphenous vein graft lesions: meta-analysis of randomized trials

TCT-673 Drug-eluting stents versus bare metal stents for saphenous vein graft lesions: meta-analysis of randomized trials

Intravascular Ultrasound Analysis of Plaque Characteristics and Postpercutaneous Coronary Intervention Catheterization Outcomes According to the Remodeling Pattern in Narrowed Saphenous Vein Grafts

We assessed the plaque characteristics and postpercutaneous coronary intervention (PCI) outcome according to the remodeling pattern (positive remodeling [PR], n = 113; and intermediate/negative remodeling [IR/NR], n = 198) in 311 saphenous vein graft lesions using intravascular ultrasound. The remodeling index was the ratio of the lesion site saphenous vein graft area to the mean of the proximal and distal references (PR/remodeling index >1.05, IR 0.95 to 1.05, and NR <0.95). Tissue prolapse was defined as tissue extrusion through the stent strut after PCI, and the tissue prolapse volume was calculated by subtracting the lumen volume from the stent volume. The presence of hypoechoic plaque (59% vs 36%, p = 0.001), plaque rupture (26% vs 16%, p = 0.042), multiple plaque rupture (12% vs 5%, p = 0.020), and an intraluminal mass (59% vs 41%, p = 0.002) were more common in the PR lesions than in the IR/NR lesions. The plaque cavity area was significantly greater in the PR lesions than in the IR/NR lesions (0.83 ± 1.43 mm(2) vs 0.42 ± 1.07 mm(2), p = 0.009). Post-PCI no-reflow (19% vs 9%, p = 0.019) and post-PCI tissue prolapse (53% vs 27%, p <0.001) were observed more frequently, and the tissue prolapse volume was significantly greater after PCI for PR lesions than for IR/NR lesions (0.86 ± 1.30 mm(3) vs 0.34 ± 0.74 mm(3), p <0.001). PR was the independent predictor of post-PCI no-reflow (odds ratio 2.58, 95% confidence interval 1.25 to 5.64, p = 0.040) and post-PCI tissue prolapse (odds ratio 2.45, 95% confidence interval 1.46 to 5.41, p = 0.045). In conclusion, saphenous vein graft lesions with PR have vulnerable plaque and are associated with no-reflow and tissue prolapse after PCI.

Intra-Graft Abciximab and Verapamil Combined with Direct Stenting is a Safe and Effective Strategy to Prevent Slow-flow and No-Reflow Phenomenon in Saphenous Vein Graft Lesions not Associated with Thrombus

Slow flow and no-reflow phenomenon (SF-NR) in saphenous vein grafts (SVG) stenting is related to the occurrence of distal plaque embolization, platelet activation and microvascular vasospasm. Our article discusses few of the patents related to strategies for preventing slow-flow/no-reflow phenomenon in SVG percutaneous coronary intervention (SVG PCI). Data from 163 consecutive patients who underwent PCI of SVG lesions without visible macro-thrombus without use of distal embolic protection device over a 10-year period were reviewed. Patients in the novel strategy group received prophylactic intra-graft administration of abciximab and verapamil followed by direct stenting (n=91). The control group (n=72) comprised of patients who had undergone conventional PCI technique before the routine availability of distal embolic protection devices, with balloon pre-dilatation of the target lesion followed by stent deployment and optional use of intragraft verapamil or intravenous abciximab. Patients with visible macro-thrombus in the vein graft were excluded from the study, since these patients underwent PCI with use of the distal embolic protection (filter). SF-NR (TIMI 0-1 flow) occurred more frequently in the control group compared to the novel strategy group (18% vs. 1%, P=0.0001). One patient in the control group died after developing persistent SF-NR and acute MI post-PCI. No death was reported in the novel strategy group. In the control group, 13% patients developed cardiac enzyme elevation 3 times more than normal after the PCI as compared to 1% in the novel strategy group (P < 0.05). In recent years several distal embolic protection devices have been granted patents for minimizing the chance of slow-flow/no-reflow phenomenon. In carefully selected subgroup of SVG lesions without visible macrothrombus, a strategy of prophylactic intra-graft administration of abciximab and verapamil, combined with direct stenting of the graft lesion without pre-dilatation, can be safely accomplished without any significant risk of slow-flow/no-reflow phenomenon. We propose a patent to this 3-step strategy of percutaneous coronary intervention of SVG lesions not associated with thrombus.

Tratamento de bifurcações coronárias: simplifique, mas não exagere

he percutaneous treatment of coronary bifurcation lesions is, together with the treatment of lesions in degenerate saphenous vein grafts and chronic occlusions, one of the biggest challenges that an inter-ventional cardiologist faces in daily practice. Several techniques for treating bifurcations have been described in addition to algorithms to indicate these techniques based on the calibre of the secondary branch and its angulation on the level of lesion involvement, but so far none has surpassed the simplicity of the provisional technique. In this issue of the

Comparison of Frequency of Complications With On-Label Versus Off-Label Use of Rotational Atherectomy

Although rotational atherectomy (RA) is used for complex lesions in percutaneous coronary intervention, there are several contraindications and precautions. The purpose of our study was to compare complications between off-label and on-label use of RA. We identified 250 consecutive patients who underwent RA. Off-label characteristics included saphenous vein graft lesions, presence of thrombus, unprotected left main stenosis, coronary artery dissection, acute myocardial infarction (MI), left ventricular dysfunction, 3-vessel disease, long lesion (≥ 25 mm), or angulated lesion (≥ 45°). Patients who had ≥ 1 off-label characteristic were assigned to the off-label group (156 patients), and patients who had no off-label characteristics were assigned to the on-label group (94 patients). Occurrence of slow flow or periprocedural MI in the off-label group was higher than that in the on-label group (slow flow 30% vs 18%, p = 0.06; MI 8.8% vs 2.1%, p = 0.04), whereas severe complications such as burr entrapment, transection of the guidewire, or perforation were rare in the 2 groups. In conclusion, compared to the on-label group, the off-label group had a higher incidence of slow flow and periprocedural MI. Severe complications such as burr entrapment, transection of the guidewire, or perforation were rare in the 2 groups.

037 Drug eluting stents (DES) offer benefit over bare metal stents (BMS) inserted during vein graft PCI

BackgroundResearch trials have shown improved short-term outcome with DES over BMS in Saphenous vein graft (SVG) PCI, primarily by reducing target vessel revascularisation (TVR) for in-Stent Restenosis (ISR). Because of...

Distal protection devices in primary percutaneous coronary intervention of native coronary artery lesions: a meta-analysis of randomized controlled trials

Objective:The use of embolic protection devices to decrease major adverse cardiac events (MACEs) in patients with saphenous vein graft lesions is considered class I therapy by the recent practice guidelines. However, the benefits of adjunctive protection devices to prevent distal embolization in patients with native coronary artery lesions are still a matter of debate. Therefore, we performed the meta-analysis to determine whether the use of distal protection devices during revascularization can improve myocardial perfusion and reduce the occurrence of MACEs compared with primary percutaneous coronary intervention (PCI) alone.Methods and results:Studies were identified in English-language articles by search of Medline and Embase database (inception to December 2011). A total of 15 prospective randomized controlled trials involving 2783 patients were included for analysis (1378 patients in the distal protection device group and 1405 cases in the control group). Overall, adjunctive embolic protection was associated with significantly improved postprocedural TIMI 3 (thrombolysis in myocardial infarction 3) flow (OR 1.71; 95% CI 1.13–2.57; P = 0.01) and MBG 3 (myocardial blush grade 3) (OR 1.50; 95% CI 1.09–2.07; P = 0.01), whereas the overall MACEs analysis demonstrated that a nonsignificant trend was observed toward better clinical outcomes associated with adjunctive protection devices at 1 month (OR 0.80; 95% CI 0.55–1.15; P = 0.23) and at 6 months (OR 0.80; 95% CI 0.55–1.17; P = 0.24). When stratified by MACEs, no statistical differences were found among mortality, reinfarction, and target vessel revascularization (TVR), respectively.Conclusions:The meta-analysis indicated an improvement of myocardial perfusion in AMI patients treated with adjunctive protection devices. However, a nonsignificant trend was observed toward a lower risk of MACEs in the distal protection device group when compared with the control group.

FOLLOW UP OF THE PATIENTS TREATED WITH THE MGUARD STENT SYSTEM IN PERCUTANEOUS CORONARY INTERVENTION AT AFIC - NIHD

The objective of this study was to conduct a follow up of the patients treated with the MGuard Stent used in Percutaneous Coronary Intervention (PCI) in the setting of acute coronary syndromes at AFIC - NIHD. Introduction: The consequences of distal embolisation during PCI in acute coronary syndrome can vary from a simple sluggish flow to myocardial infarction and death. A number of protection devices reduce distal embolisation, but they add complexity and cost to the procedure. The MGuard stent is a unique innovation to counter the phenomenon. Objective: The objective of this study was to conduct an angiographic follow up of the patients treated with the MGuard Stent used in Percutaneous Coronary Intervention (PCI) in the setting of acute coronary syndromes at AFIC - NIHD. Patients and Methods: The study was conducted in AFIC - NIHD. Between April 2010 to date 21 patients were treated with a total of 25 MGuard stents. Inclusion criteria included de novo lesions in saphenous vein grafts or native vessels with angiographic evidence of thrombus activity or lesion instability and a potential for distal embolization, all in the setting of acute coronary syndromes. Results: All patients were male. Mean age was 46.23 years (range 32-70 years). All patients were admitted with acute coronary syndromes. Most lesions had complex morphological features and all had some thrombus activity. The MGuard stent was deployed successfully in all cases and without any complications. Secondary endpoints (TIMI - III flow and myocardial blush grade 3) were met in all cases. There was no elevation of cardiac enzymes post procedure in any patient.On follow up Nine patients (42%) had critical ISR (2 of these were total occlusions) and all required repeat intervention.One patient died within 30 days of PCI. Conclusions: These preliminary results show that the MGuard stent is a safe option for patients undergoing PCI in de novo coronary artery lesions in the setting of acute coronary syndrome with thrombus burden and saphenous vein graft stenosis. However the long term follow up of these patients shows significant ISR which needs to be clarified with a larger sample size.

Intravascular Ultrasound Findings That Are Predictive of No Reflow After Percutaneous Coronary Intervention for Saphenous Vein Graft Disease

The aim of this study was to investigate the relation between intravascular ultrasound (IVUS) findings and the no-reflow phenomenon and long-term outcome after percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) lesions. No reflow was defined as Thrombolysis In Myocardial Infarction grade 0, 1, or 2 flow after PCI. Of 311 patients who underwent IVUS before and after stenting, no reflow was observed in 39 patients (13%). Degenerated SVG (62% vs 36%, p = 0.002), IVUS-detected intraluminal mass (82% vs 43%, p <0.001), culprit lesion multiple plaque ruptures (23% vs 6%, p <0.001), and tissue prolapse (51% vs 35%, p = 0.043) were observed more frequently in patients with no reflow. In multivariate logistic regression analysis, an intraluminal mass (odds ratio [OR] 4.84, 95% confidence interval [CI] 1.98 to 10.49, p = 0.001), culprit lesion multiple plaque ruptures (OR 3.46, 95% CI 1.46 to 8.41, p = 0.014), and degenerated SVGs (OR 3.17, 95% CI 1.17 to 6.56, p = 0.024) were the independent predictors of no reflow after PCI. At 5-year clinical follow-up, rates of death (14, 36%, vs 55, 20%, p = 0.036) and myocardial infarction (13, 33%, vs 52, 19%, p = 0.039) were significantly higher in the no-reflow group. However, rate of target vessel revascularization was not significantly different between the 2 groups (15, 38%, vs 90, 33%, p = 0.3). IVUS-detected intraluminal mass, multiple plaque ruptures, and degenerated SVGs were associated with no reflow in SVG lesions after PCI. In conclusion, no reflow was associated with poor long-term clinical outcomes after PCI for SVG lesions.

Role of embolic protection devices in ostial saphenous vein graft lesions

Although embolic protection devices (EPDs) have been shown to be beneficial in saphenous vein graft (SVG) lesions, their role in the subgroup of ostial SVG lesions has received limited study. The coronary angiograms and procedural outcomes of 109 patients undergoing stenting of 113 ostial SVG lesions were retrospectively reviewed to determine the frequency of EPD use and the periprocedural outcomes. Ninety-eight (87%) of the 113 lesions were suitable for EPD use, that was used in 70 lesions (71%). A Filterwire (Boston Scientific) or a SPIDER (ev3) filter were used in 54 (77%) and 16 (23%) of lesions, respectively. Difficulty retrieving the filter post stenting was encountered in eight lesions (11%) and led to stent thrombosis causing cardiac arrest in one patient (1%). Angiographic success was achieved in 111 (98%) of 113 lesions. EPDs can be utilized in the majority of ostial SVG lesions, but in 11% of cases filter retrieval can be challenging and may rarely (in approximately 1%) lead to a significant complication.

Early beneficial effects of drug‐eluting stents in vein grafts wane during long term follow‐up

The aim of the study was to compare outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in saphenous vein graft (SVG) interventions in a case-control study with a long-term follow-up. Safety and efficacy of DES in SVG interventions are still controversial. We performed a multicenter registry assessing clinical outcomes with DES vs. BMS. We included 311 patients (239 men, age 68 ± 8 years) who underwent percutaneous coronary interventions (PCI) of SVG lesions with DES (n = 138) or BMS (n = 173) with a 2-year follow-up. The two groups were similar for age, sex, main risk factors, incidence of diabetes, use of IIb/IIIa antagonists, use of aspiration devices or filters, number of stents, and total stent length. Overall, at 9 months follow-up incidence of major adverse cardiac events (MACE) and target vessel revascularization (TVR) were significantly lower in the DES group compared with the BMS group (10.9% vs. 22.0%, P = 0.014 and 8.7% vs. 19.1% in DES and BMS respectively, P = 0.015), while there was no significant difference in incidence of myocardial infarction (5.1% vs. 5.2%, P = 0.96) or death (2.2% vs. 4%, respectively, P = 0.54). However, at 24-month follow-up incidence of MACE was 29.7% in the DES group and 37.0% in BMS group (P = 0.29); incidence of TVR (23.2% vs. 28.9% P = 0.39), myocardial infarction (9.4% vs. 9.2%), death (7.2% vs. 6.9%) were also similar in the two groups. Although DES appear safe, our findings suggest that the early benefit of DES in SVG may rapidly wane during long-term follow-up.