Saphenous Vein Graft Intervention Research Articles

PP-030 Manual Thrombus Aspiration and High-dose Adenosine via Thrombus Aspiration Catheter in the Treatment of No-reflow for Saphenous Vein Graft Intervention in ST-elevation Myocardial Infarction

Lale Dinc Asarcikli, Ahmet Akyel, Tolga Cimen, Hamza Sunman, Hilal Erken Pamukcu, Tolgahan Efe, Murat Bilgin, Mehmet Dogan, Ekrem Yeter. Department of Cardiology, Ministry of Health Diskapi Research and Educational Hospital. Background: Percutaneous interventions for safenous vein grafts (SVGs) carry higher risk of no-reflow. The emboli protection devices may be used in this setting. However, these devices are not utilisied in many cases of ST-elevation myocardial infarction (STEMI). We report that 64-year old man history of coronary bypass surgery presented with inferior STEMI. Coronary angiography (CAG) revealed proximal total occlusion of SVG. Method: 0.014-inch floppy guidewire was passed through the total occlusion of SVG. Thrombus aspiration was performed to attenuate thrombus burden, and better characterize SVG anatomy by avoiding unnecessary balloon angioplasty. Despite successful retrieval of macroscopic thrombus, no-reflow occurred. Intracoronary tirofiban bolus was started. We decided to use higher-dose adenosine for relieving microvascular obstruction by using manual thrombus aspiration catheter. Because of the short half life of adenosine, we firstly positioned thrombus aspiration catheter distal coronary artery to give adenosine efficiently into the microvascular bed. After higher-dose adenosine with the total dose of 5 mg, blood aspirations via aspiration catheter were employed from distal to the proximal part of SVG. CAG revealed resolution of no-reflow. Finally, 2.5x20 mm sized drug eluting stent was deployed to stenosis at the distal anastomosis. Discussion: Thrombus aspiration is a popular technique to remove thrombus, and is recommended in STEMI. However, it is not wellknown whether coronary thrombus aspiration is associated with improved outcomes for SVG interventions. After thrombus aspiration, we performed different technique to overcome no-reflow, and higher thrombus burden by giving tirofiban and higher dose adenosine into microvascular circulation via distal positioned thrombus aspiration catheter. Although some evidence has suggested that a number of therapies might have a role in the no-reflow treatment, we believe that many open questions remain, including the optimal patient selection and the delivery method of therapies into SVG. Conclusion: The combination of different techniques and medical therapies is required to overcome no-reflow for SVGs, as in our case. TERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY ARDIOVASCULAR SURGERY ABSTRACTS / Poster S109

Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry.

Information is limited on contemporary use and outcomes of embolic protection devices (EPDs) in saphenous vein graft interventions. We formed a longitudinal cohort (2005-2009; n=49 325) by linking National Cardiovascular Data Registry CathPCI Registry to Medicare claims to examine the association between EPD use and both procedural and long-term outcomes among seniors (65+ years), adjusting for clinical factors using propensity and instrumental variable methodologies. Prespecified high-risk subgroups included acute coronary syndrome and de novo or graft body lesions. EPDs were used in 21.2% of saphenous vein grafts (median age, 75; 23% women) and were more common in acute coronary syndrome (versus non-acute coronary syndrome; 22% versus 19%), de novo (versus restenotic; 22% versus 14%), and graft body lesions (versus aortic and distal anastomosis; 24% versus 20% versus 8%, respectively). EPDs were associated with a slightly higher incidence of procedural complications, including no reflow (3.9% versus 2.8%; P<0.001), vessel dissection (1.3% versus 1.1%; P=0.05), perforation (0.7% versus 0.4%; P=0.001), and periprocedural myocardial infarction (2.8% versus 1.8%; P<0.001). By 3 years, death, myocardial infarction, and repeat revascularization occurred in 25%, 15%, and 30% of cases, respectively. EPD use was associated with a similar adjusted risk of death (propensity score-matched hazard ratio, 0.96; 95% confidence interval, 0.91-1.02), myocardial infarction (propensity score-matched hazard ratio, 1.00; 95% confidence interval, 0.93-1.09), and repeat revascularization (propensity score-matched hazard ratio, 1.02; 95% confidence interval, 0.96-1.08) in the overall cohort and high-risk subgroups. In this contemporary cohort, EPDs were used more commonly among patients with high-risk clinical indications, yet there was no evidence of improved acute- or long-term outcomes. Further prospective studies are needed to support routine EPD use.

Bioresorbable vascular scaffolds in saphenous vein grafts (data from OCTOPUS registry)

Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) with metallic stents is associated with a high rate of restenosis (19–21%) and target vessel failure in the long-term follow-up [1]. Potentially, implantation of a bioresorbable vascular scaffold (BVS) (ABSORB, Abbott Laboratories) into the stenotic SVG may be an alternative to metallic stents [2]. Although the effectiveness of BVS in treatment of de novo coronary lesions in native vessels is well documented [3], none of the previous studies evaluated the results of BVS implantation into SVG. Recently, we reported an imaging follow-up of a case of successful BVS implantation to treat a de novo stenotic SVG lesion [4–6]. Therefore, in this report we present pilot results from the OCTOPUS registry of a subgroup of patients with significant de novo SVG stenosis treated with BVS implantation.

Rupture iatrogène intrastent d’un pontage aorto-coronaire veineux traitée avec succès par endoprothèse couverte

Percutaneous coronary interventions of saphenous vein grafts are associated with an increased risk of periprocedural complications; among these, the rupture of the vein graft is probably the less common and the most dangerous; it is even more exceptional when it occurs on a stented portion of the graft. We report the case of a 75-year-old man who presented during a balloon angioplasty of intent restenosis of a saphenous vein graft a spectacular graft rupture at the level of the previously stented site and who was ultimately successfully treated with a covered stent.

Novel use of absorb bioresorbable vascular scaffold and STENTYS self-apposing coronary stent for complex saphenous vein grafts intervention

Novel use of absorb bioresorbable vascular scaffold and STENTYS self-apposing coronary stent for complex saphenous vein grafts intervention

Recurrent restenosis in saphenous vein graft. What is the next step?

The long-term outcome after percutaneous treatment of saphenous vein graft (SVG) is worse than of native coronaries. We present a patient with degenerated SVG, which had been treated with several interventions. Despite this, there was multiple recurrence of SVG-restenosis. A 76-year-old patient after implantation of a cardiac pacemaker, with arterial hypertension, atrial fibrillation, and chronic kidney disease, underwent coronary artery bypass grafting in 1993. Left internal mammary artery to left anterior descending artery, jump-SVG to marginal (Marg) and diagonal branches and SVG to right coronary artery (RCA) were inserted. Control angiography carried out 18 years later revealed occluded native coronary arteries and occluded SVG segment to Marg. Additionally, there was tight stenosis in RCA-SVG (Fig. 1A). Immediate intravascular ultrasound-guided percutaneous coronary intervention (PCI) of RCA-SVG was done with a 2.5 × 12 mm paclitaxel-eluting stent implantation and postdilatation. Seven months later, tight in-stent restenosis was diagnosed (Fig. 1B). After predilatation, a 2.5 × 18 mm zotarolimus-eluting stent was implanted. Subsequent two in-stent restenoses a few months later were treated twice with 3.0 × 25 mm paclitaxel-eluting balloons (Figs. 1C, D). The last in-stent restenosis (Fig. 1E) was treated with a 3.0 × 15 mm everolimus-eluting stent. There is no convincing proof of better long-term outcomes after SVG-PCI with drug-eluting stents (DES) compared to bare metal stents (BMS). DES significantly reduces the target vessel revascularisation (TVR) in SVG. However, there is no clear benefit on mortality and myocardial infarction. Histological examination of SVG-lesions shows a different pattern of restenosis compared to native coronaries, with enhanced inflammatory and thrombotic response. A Japanese restenosis registry in native coronaries indicated that if the original restenosis developed in a sirolimus-eluting stent (SES), it would more likely occur again after the next in-stent SES implantation. However, the need for TVR for second restenosis was rarer, if the original restenosis developed in BMS (and not in SES) and was subsequently treated with in-BMS SES implantation. Both first and second generation DES failed in our case. There have been no direct comparisons from randomised trials of different DES types for SVG. Chatani et al. (J Interv Cadiol, 2009; 22: 354–361) suggested that the only independent predictive factor of re-restenosis after SES-in-SES implantation in native coronaries was the reference diameter. In our case, we implanted two second generation DESs into a first generation DES. Additionally, two PCIs with drug-eluting balloons, postponed further metal jacket insertion. After careful lesion preparation, implantation of the last (third) DES with larger diameter than the previous stents was possible. DESs have the advantage over BMSs in terms of SVG-TVR reduction, but in rare cases both DESs of first and second generation and drug-eluting balloon fail to prevent it. If a sixth restenosis were to occur, implantation of bioabsorbable vessel scaffolding or rotablation might be the treatment option.

TCTAP C-147 Saphenous Vein Graft Intervention with Bioresorbable Vascular Scaffold and Self Apposing Stents

TCTAP C-147 Saphenous Vein Graft Intervention with Bioresorbable Vascular Scaffold and Self Apposing Stents

Saphenous Vein Graft Interventions

Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) currently accounts for approximately 6% of all PCIs and is associated with increased risk for distal embolization and subsequent SVG failure compared with native coronary artery PCI. To minimize the risk for distal embolization, embolic protection devices should be used during SVG PCI when technically feasible. To minimize the risk for in-stent restenosis and the need for repeat PCI, drug eluting stents should be utilized in patients without contraindications to long-term antiplatelet therapy. Treating native coronary artery lesions is preferable to SVG PCI when technically feasible.

Release and Capture of Bioactive Oxidized Phospholipids and Oxidized Cholesteryl Esters During Percutaneous Coronary and Peripheral Arterial Interventions in Humans

This study sought to assess whether oxidized lipids are released downstream from obstructive plaques after percutaneous coronary and peripheral interventions using distal protection devices. Oxidation of lipoproteins generates multiple bioactive oxidized lipids that affect atherothrombosis and endothelial function. Direct evidence of their role during therapeutic procedures, which may result in no-reflow phenomenon, myocardial infarction, and stroke, is lacking. The presence of specific oxidized lipids was assessed in embolized material captured by distal protection filter devices during uncomplicated saphenous vein graft, carotid, renal, and superficial femoral artery interventions. The presence of oxidized phospholipids (OxPL) and oxidized cholesteryl esters (OxCE) was evaluated in 24 filters using liquid chromatography, tandem mass spectrometry, enzyme-linked immunosorbent assays, and immunostaining. Phosphatidylcholine-containing OxPL, including (1-palmitoyl-2-[9-oxo-nonanoyl] PC), representing a major phosphatidylcholine-OxPL molecule quantitated within plaque material, [1-palmitoyl-2-(5-oxo-valeroyl)-sn-glycero-3-phosphocholine], and 1-palmitoyl-2-glutaroyl-sn-glycero-3-phosphocholine, were identified in the extracted lipid portion from all vascular beds. Several species of OxCE, such as keto, hydroperoxide, hydroxy, and epoxy cholesteryl ester derivatives from cholesteryl linoleate and cholesteryl arachidonate, were also present. The presence of OxPL was confirmed using enzyme-linked immunoassays and immunohistochemistry of captured material. This study documents the direct release and capture of OxPL and OxCE during percutaneous interventions from multiple arterial beds in humans. Entrance of bioactive oxidized lipids into the microcirculation may mediate adverse clinical outcomes during therapeutic procedures.

4-Year Clinical Outcomes and Predictors of Repeat Revascularization in Patients Treated With New-Generation Drug-Eluting Stents: A Report From the RESOLUTE All-Comers Trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention)

The aim of the study was to investigate 4-year outcomes and predictors of repeat revascularization in patients treated with the Resolute zotarolimus-eluting stent (R-ZES) (Medtronic, Minneapolis, Minnesota) and XIENCE V everolimus-eluting stent (EES) (Abbott Vascular, Abbott Park, Illinois) in the RESOLUTE (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention) All-Comers trial. Data on long-term outcomes of new-generation drug-eluting stents are limited, and predictors of repeat revascularization due to restenosis and/or progression of disease are largely unknown. Patients were randomly assigned to treatment with the R-ZES (n = 1,140) or the EES (n = 1,152). We assessed pre-specified safety and efficacy outcomes at 4 years including target lesion failure and stent thrombosis. Predictors of revascularization at 4 years were identified by Cox regression analysis. At 4 years, the rates of target lesion failure (15.2% vs. 14.6%, p = 0.68), cardiac death (5.4% vs. 4.7%, p = 0.44), and target vessel myocardial infarction (5.3% vs. 5.4%, p = 1.00), clinically-indicated target lesion revascularization (TLR) (7.0% vs. 6.5%, p = 0.62), and definite/probable stent thrombosis (2.3% vs. 1.6%, p = 0.23) were similar with the R-ZES and EES. Independent predictors of TLR were age, insulin-treated diabetes, SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score, treatment of saphenous vein grafts, ostial lesions, and in-stent restenosis. Independent predictors of any revascularization were age, diabetes, previous percutaneous coronary intervention, absence of ST-segment elevation myocardial infarction, smaller reference vessel diameter, SYNTAX score, and treatment of left anterior descending, right coronary artery, saphenous vein grafts, ostial lesions, or in-stent restenosis. R-ZES and EES demonstrated similar safety and efficacy throughout 4 years. TLR represented less than one-half of all repeat revascularization procedures. Patient- and lesion-related factors predicting the risk of TLR and any revascularization showed considerable overlap. (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention [RESOLUTE-AC]; NCT00617084).

Cardioprotective effect of high‐dose intragraft adenosine infusion on microvascular function and prevention of no‐reflow during saphenous vein grafts intervention

Despite the use of embolic protection devices, no-reflow can still occur during saphenous vein grafts (SVGs) intervention. High-dose intracoronary adenosine infusion preconditions the myocardium, improves coronary flow, and prevents no-reflow. The role of high-dose intragraft adenosine infusion on protection of microvascular function and prevention of no-reflow has not been investigated We investigated the cardioprotective effect of high-dose intragraft adenosine infusion, compared with placebo, on microvascular function and prevention of no-reflow during SVGs intervention. We randomized 22 patients with SVGs stenoses to receive either a 10-min intragraft adenosine infusion (200 μg/min; total dose = 2,000 μg) or normal saline prior to stenting. Average peak velocity (APV), coronary flow velocity reserve (CVR), thrombolysis in myocardial infarction (TIMI) frame count (TFC), TIMI myocardial perfusion grade (TMPG), and the rate of no-reflow were compared between the two groups before adenosine or saline infusions and after stenting After stenting, hyperemic APV, CVR, and TMPG were significantly higher in the adenosine-treated group than in the control group (60 ± 18 vs. 35 ± 10 cm/sec; 2.6 ± 0.54 vs. 1.8 ± 0.47; and 2.8 ± 0.90 vs. 2.1 ± 0.80, respectively; P < 0.05. TFC was significantly lower in the adenosine-treated group than in the control group (14 ± 3.0 vs. 26 ± 13; P < 0.05). In the control group, four patients (36%) developed no-reflow compared to none in the adenosine-treated patient; P < 0.05 CONCLUSIONS: This study provides the first evidence that high-dose intragraft adenosine infusion compared with placebo protects microvascular function and prevents no-reflow during SVGs intervention.

Treatment of saphenous vein graft disease: "never ending story" of the "eternal return".

Treatment of saphenous vein graft disease: "never ending story" of the "eternal return".

Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts

Newer-generation everolimus-eluting stents (EES) have been shown to improve clinical outcomes compared with early-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in patients undergoing percutaneous coronary intervention (PCI). Whether this benefit is maintained among patients with saphenous vein graft (SVG) disease remains controversial. We assessed cumulative incidence rates (CIR) per 100 patient years after inverse probability of treatment weighting to compare clinical outcomes. The pre-specified primary endpoint was the composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR). Out of 12,339 consecutively treated patients, 288 patients (5.7%) underwent PCI of at least one SVG lesion with EES (n=127), SES (n=103) or PES (n=58). Up to four years, CIR of the primary endpoint were 58.7 for EES, 45.2 for SES and 45.6 for PES with similar adjusted risks between groups (EES vs. SES; HR 0.94, 95% CI: 0.55-1.60, EES vs. PES; HR 1.07, 95% CI: 0.60-1.91). Adjusted risks showed no significant differences between stent types for cardiac death, MI and TVR. Among patients undergoing PCI for SVG lesions, newer-generation EES have similar safety and efficacy to early-generation SES and PES during long-term follow-up to four years.

TCT-175 Does Diabetes Mellitus Impact Long-Term Clinical Outcomes After Percutaneous Coronary Saphenous Vein Graft Interventions In The Drug-Eluting Stent Era?

Patients with diabetes mellitus were shown to have less favorable outcomes after saphenous vein graft (SVG) intervention with bare metal stents while its impact with drug-eluting stents (DES) is not clearly defined. We aimed to compare clinical outcomes in diabetic patients who underwent SVG

Stent Thrombosis after Coronary Stent Implantation: A Protective Effect of High-Dose Statin Therapy?

Objectives: To assess independent predictors of stent thrombosis (ST) in an all-comer trial. Methods: This is an observational case-control study based on a retrospective analysis of the Basel Stent Kosten Effektivitäts Trial (BASKET) (n = 826). Patients with ST were compared to controls with regard to baseline parameters. Multivariate models were performed to identify independent predictors of ST. Results: At 36 months, there were 53 (6.4%) patients with ST, 17 (32%) of whom had early ST and 36 (68%) of whom had late/very late ST. Patients with ST were at a higher cardiovascular risk but received lower doses of statins than the controls (n = 212). Stents in ST patients were longer, had more overlap and were not as well expanded, with significantly more remaining stenoses than the stents in the controls. Multivariable analysis revealed interventions in saphenous vein grafts, malapposed stents, an overlap >3 mm, complex coronary anatomy and treatment with low-dose/no statins as risk factors for ST, while interventions in saphenous vein grafts, underexpanded or malapposed stents, a history of myocardial infarction and treatment with low-dose/no statins were risk factors for late ST. Conclusions: The use of statins might have a protective effect against ST. This observation is new, hypothesis-generating and should be evaluated in an adequately powered randomized trial.

Saphenous vein graft intervention versus percutaneous coronary intervention for the native coronary artery in patients with prior coronary artery bypass grafting

Saphenous vein graft intervention versus percutaneous coronary intervention for the native coronary artery in patients with prior coronary artery bypass grafting

Long term follow‐up of drug eluting versus bare metal stents in the treatment of saphenous vein graft lesions

The safety and effectiveness of drug-eluting stent (DES) compared with bare metal stents (BMS) for the treatment of saphenous vein graft (SVG) disease is controversial, especially because of the lack of long-term follow-up. The aim of this study was to address the late outcome of DES versus BMS for the treatment of SVG lesions. A matched, case-control study included 82 patients in each group. Patients groups were matched by gender, age, clinical presentation, and diabetes. The primary study end point was occurrence of major adverse cardiovascular events (MACE). Secondary end points included death, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR). Clinical and angiographic characteristics were similar between the groups. At 6 months, TVR (hazard ratio [HR] 6.12, 95% confidence interval [CI] 1.39 to 26.93, P = 0.05), and MACE (HR 2.54, 95% CI 1.08 to 5.98, P = 0.04) were higher in the BMS group. At 4 years the risks of MI (P = 0.21), TVR (P = 0.99), and MACE (P = 0.21) were similar between both groups. However, the rates of death (HR 2.74, 95% CI 1.11 to 6.74, P = 0.04) and cardiac death (HR 4.26, 95% CI 1.59 to 11.35, P = 0.01) were significantly higher in the BMS group. These results suggest that the use of DES compared with BMS in the treatment of SVG lesions reduces TVR and MACE at 6 months of follow-up, a benefit that was lost over the next 3-4 years.

Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Grafting (from the j-Cypher Registry)

A paucity of data is available from large-scale studies evaluating the long-term outcomes of percutaneous coronary intervention in patients who had previously undergone coronary artery bypass grafting (CABG) in the drug-eluting stent era. Of 12,812 patients who had undergone sirolimus-eluting stent implantation in the j-Cypher registry, 919 (7.2%) had a history of CABG and had significantly higher crude 5-year mortality (19.9% vs 14.0%, p<0.001). After adjusting for confounders, the excess risk of death was no longer significant (hazard ratio 0.99, 95% confidence interval 0.83 to 1.18, p= 0.90), and the adjusted risk of target lesion revascularization was significantly higher in patients with previous CABG than in those without (hazard ratio 1.25, 95% confidence interval 1.06 to 1.47, p= 0.01). Of the patients with previous CABG, those who had undergone ≥1 saphenous vein graft intervention had significantly higher adjusted risks of cardiac death (hazard ratio 2.21, 95% confidence interval 1.26 to 3.76, p= 0.01), myocardial infarction (hazard ratio 2.56, 95% confidence interval 1.10 to 5.60, p= 0.03), target lesion revascularization (hazard ratio 2.65, 95% confidence interval 1.82 to 3.81, p <0.001), and definite stent thrombosis (hazard ratio 7.70, 95% confidence interval 1.99 to 29.1, p= 0.004) compared with those who underwent percutaneous coronary intervention only for the native coronary artery. In conclusion, the adjusted mortality was similar between patients with and without previous CABG, despite a significantly different risk of target lesion revascularization. Among the patients with previous CABG, those with saphenous vein graft intervention using a first-generation drug-eluting stent had worse clinical outcomes than those with a native coronary artery target only.

Current percutaneous treatment strategies for saphenous vein graft disease

Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research.

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

INTRODUÇÃO: 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). MÉTODOS: Entre maio de 2002 e janeiro de 2013, pacientes submetidos a ICP com SF no Hospital do Coração foram incluídos no Registro DESIRE. Avaliamos os resultados de pacientes submetidos a ICP em pontes de safena (grupo 1), que foram comparados aos submetidos a ICP em vasos nativos (grupo 2). RESULTADOS: De um total de 4.655 pacientes, 311 foram incluídos 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 miocárdio 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 revascularização da lesão-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). CONCLUSÕES: A despeito do inquestionável benefício dos SFs nos resultados tardios de ICP em pacientes complexos, o tratamento de pacientes com lesões em pontes de safena ainda permanece um desafio, com resultados agudos e tardios menos favoráveis que os de pacientes com lesões em vasos nativos.