Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Favourable results of treatment of narrowed saphenous vein grafts with Palmaz-Schatz stent implantation
Catheterization Laboratory, Centro Cuore Columbus Milan, Italy
Received 4 November 1993; revised 14 May 1994; .
Correspondence: Luigi Maiello. MD, Centro Cuore Columbus, Via Buonarrou 48, 20145 Milan, Italy.
Abstract
Although conventional balloon angioplasty of Saphenous vein grafts can be performed with an acceptable acute success and complication rate, restenosis remains a major problem. However, this may be overcome by the implantation of Palmaz-Schatz stents. Palmaz-Schatz stent deployment was performed in our institution in 43 patients who were referred for PTCA of stenosed saphenous vein grafts. Thirty-seven were located at the mid-portion of the graft, seven at the ostium and six at the distal anastomosis. Overall, we used 59 standard length (15 mm) Palmaz-Schatz stents and 22 short (7 mm) stents. In 15 lesions (30%) multiple stents were implanted in tandem to treat diffuse disease. Angiographic success was achieved in 47 of the 50 attempted lesions (94%).
Major cardiac complications occurred in three patients. Two patients had procedures complicated by the development of a Q wave myocardial infarction, one of whom underwent urgent CABG. One patient died. There was no episode of subacute thrombosis.
The angiographic follow-up of 37 lesions (80% of eligible lesions) at a mean time of 5 ± 2 months (range 1–8) showed a restenosis rate of 11%, and residual post-stent diameter stenosis was associated with a significantly higher restenosis rate. However, no restenosis occured in lesions receiving multiple stents. Clinical follow-up was performed in all patients, and at a mean of 25 months after the procedure, 64% were free from clinical events, including recurrent angina.
Palmaz-Schatz stent implantation is an effective and safe procedure to treat narrowed vein grafts. Particularly encouraging were the results of stent implantation for ostimum or mid-portion graft stenoses, as well as the use of multiple stents for the treatment of diffuse disease.
Key Words: Sephenous vein grafts • intravascular stents • angioplasty
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