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Clinical presentation and angiographic characteristics of saphenous vein graft failure after stenting: insights from the SOS (stenting of saphenous vein grafts) trial
Journal article   Open access   Peer reviewed

Clinical presentation and angiographic characteristics of saphenous vein graft failure after stenting: insights from the SOS (stenting of saphenous vein grafts) trial

Christopher Lichtenwalter, James A de Lemos, Michele Roesle, Owen Obel, Elizabeth M Holper, Donald Haagen, Bilal Saeed, Jose Miguel Iturbe, Kendrick Shunk, Joseph K Bissett, …
JACC. Cardiovascular interventions, Vol.2(9), pp.855-860
09/2009
DOI: 10.1016/j.jcin.2009.06.014
PMID: 19778774
url
https://doi.org/10.1016/j.jcin.2009.06.014View
Published (Version of record) Open Access

Abstract

We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS). The mode of SVG failure after stenting has been poorly characterized. The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients. Binary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non-ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG. SVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure.
 Single-Blind Method Recurrence Angioplasty, Balloon, Coronary - instrumentation Graft Occlusion, Vascular - diagnostic imaging Saphenous Vein - transplantation United States Humans Metals Graft Occlusion, Vascular - therapy Myocardial Infarction - diagnostic imaging Prosthesis Design Thrombosis - diagnostic imaging Greece Angioplasty, Balloon, Coronary - adverse effects Time Factors Saphenous Vein - diagnostic imaging Thrombosis - prevention & control Paclitaxel - administration & dosage Myocardial Infarction - etiology Stents Coronary Restenosis - etiology Cardiovascular Agents - administration & dosage Drug-Eluting Stents Acute Coronary Syndrome - diagnostic imaging Treatment Outcome Coronary Restenosis - diagnostic imaging Coronary Restenosis - therapy Coronary Angiography Coronary Artery Bypass - adverse effects Graft Occlusion, Vascular - etiology Thrombosis - etiology Acute Coronary Syndrome - etiology Myocardial Infarction - prevention & control Acute Coronary Syndrome - prevention & control

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