Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
The use of Gianturco-Roubin flexible metallic coronary stents in old saphenous vein grafts: in-hospital outcome and 7 day angiographic patency
*The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation Ltd. Milwaukee, WI
University of Alabama Birmingham, AL
Milwaukee Heart and Vascular Clinic S. C. Milwaukee, WI, U. S.A.
Received 21 March 1994; revised 6 June 1994; .
Correspondence: Gerald Dorros, MD, FACC, FESC. The William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation, Ltd., 2901 West Kinnickinnic River Parkway, #L064, Health-Science Offices—-2, Milwaukee, WI 53215, U. S.A.
Abstract
After placement of a Gianturco-Roubin metallic, coiled coronary stent(s) following balloon angioplasty (PTCA), a pre-discharge (7 day) angiogram determined the patency of the old coronary bypass vein graft(s) (SVG) (
5 years remote from their last surgery, mean age: 8.5 ± 1.8 years). Metallic, coiled stents were successfully deployed in 95/96 (99%) patients within 100/101 (99%) SVGs. The indications for deployment were threatened [81 patients (84%)] or acute [15 patients (16%)] vein graft closure following PTCA. Intragraft urokinase infusion was performed in 17 patients (17%) [6 patients with baseline occlusions; 11 with abrupt closure post PTCA]. Complications encountered included three (3%) in-hospital deaths (two procedure related) two (2%) Q wave myocardial infarctions, six (6%) non-Q wave myocardial infarctions, and 22 (22%) bleeding problems. These included, not mutually exclusively, 21 (22%) requiring transfusions, six (6%) cases of gastrointestinal bleeding, six (6%) pseudoaneurysms, five (5%) retroperitoneal haemorrhages and two (2%) cerebrovascular accidents. All patients received dipyridamole, aspirin, dextran, and anticoagulation (heparin 10-20 000 U intra-procedurally); a heparin infusion was continued for 5± 1 days, despite warfarin administration which attained a therapeutic prothrombin time (PT) (1.5–2 times control) by 3 ± 1 days. Out of the 95 successfully treated patients, six with eight stented grafts were ineligible for pre-discharge angiography. Of the six, three died in hospital (four SVGs). one had an intracerebral haemorrhage (one SVG), and two were asymptomatic patients with chronic renal failure (three SVGs). Predischarge 7-day angiograms were obtained in 86/89 (97%) eligible patients, of 88/92 (96%) eligible grafts with patency documented in 87/88 (99%) grafts (the one occult SVG closure was successfully recanalized with thrombolysis).
The Gianturco-Roubin metallic, coiled stent in conjunction with an aggressive anticoagulation regimen effectively restored normal flow in old SVGs following complicated balloon angioplasty. The excellent graft patency, in comparison to that in native vessels, may be related to the larger stent size, andlor the vigorous anticoagulation regimen. While the stent was immediately beneficial, its effect upon lesion recurrence, subsequent cardiac events, and survival remains to be seen
Key Words: Vein graft • Gianturco-Roubin stent • patency