Palmaz-Schatz stenting for treatment of focal vein graft stenosis: Immediate results and long-term outcome

Robert N. Piana, Mauro Moscucci, David J. Cohen, Aaron D. Kugelmass, Cynthia Senerchia, Richard E. Kuntz, Donald S. Baim, Joseph P. Carrozza

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Abstract

Objectives. This study aimed to evaluate the effectiveness of Palmaz-Schatz stenting for the treatment of saphenous vein graft stenoses. Background. Failure of saphenous vein grafts is a common cause of recurrent ischemia after coronary bypass surgery. A second bypass surgery carries more risk than the initial procedure, and balloon angioplasty of vein grafts has yielded disappointing results. It has been hoped that starting might offer a better treatment option. Methods. We examined the results of stent placement in 200 saphenous bypass graft lesions consecutively treated with either coronary (n = 146) or biliary (n = 54) Palmaz-Schatz stents. Immediate outcome and clinical follow-up (median 15.5 months) were examined in all patients. To document angiographic outcome, a second angiography was performed at 3 to 6 months for the first 120 consecutively stented lesions and was successfully obtained for 94 (78%). Results. The mean graft age (±SD) was 8.7 ± 4 years. Stent placement was successful in 197 (98.5%) of 200 lesions, reducing the mean diameter stenosis from 74 ± 14% to 1 ± 15%. In 164 procedures, there was one in-hospital death (0.6%), no emergency bypass operations and no Q wave myocardial infarctions. There was one acute stent thrombosis (0.6%) but no subacute thromboses. Vascular repair was required after 14 procedures (8.5%), with transfusion in 23 additional cases (14%). Angiographic restenosta (diameter stenosis ≥ 50%) at 3- to 6-month follow-up was 17% (95% confidence interval 9% to 25%). By Kapian-Meier estimates, however, the 2-year second revascularization rate was 49%, refecting the predominant revascularization performed to treat progressive disease at other sites because failure at the stented site occurred in only 22% of lesions. Conclusions. Stenting resulted in exellent immediate and long-term angiographic resuls in this group of focally diseased, older saphenous vein grafts. Despite the high immediate success and very low (17%) angiographic restenesis rate at 6 months, approximately one half of these patients required farther revascularization in the following 2 years, mainly because of disease progression at other sites.

Original languageEnglish (US)
Pages (from-to)1296-1304
Number of pages9
JournalJournal of the American College of Cardiology
Volume23
Issue number6
DOIs
StatePublished - May 1994

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Piana, R. N., Moscucci, M., Cohen, D. J., Kugelmass, A. D., Senerchia, C., Kuntz, R. E., Baim, D. S., & Carrozza, J. P. (1994). Palmaz-Schatz stenting for treatment of focal vein graft stenosis: Immediate results and long-term outcome. Journal of the American College of Cardiology, 23(6), 1296-1304. https://doi.org/10.1016/0735-1097(94)90370-0