A MULTICENTER, RANDOMIZED TRIAL OF CORONARY ANGIOPLASTY VERSUS DIRECTIONAL ATHERECTOMY FOR PATIENTS WITH SAPHENOUS-VEIN BYPASS GRAFT LESIONS

Background Directional coronary atherectomy and percutaneous translumi nal coronary angioplasty have both been used in symptomatic patients w ith coronary saphenous vein bypass graft stenoses. The relative merits of plaque excision and removal versus balloon dilatation remain uncer tain. We compared outcomes after directional coronary atherectomy or a ngioplasty in patients with de novo bypass graft stenoses. Methods and Results Fifty-four North American and European sites randomized 305 p atients with de novo vein graft lesions to atherectomy (n=149) or angi oplasty (n=156). Quantitative coronary angiography at a core laborator y assessed initial and 6-month results. Initial angiographic success w as greater with atherectomy (89.2% versus 79.0%), as was initial lumin al gain (1.45 versus 1.12 mm, P<.001). Distal embolization was increas ed with atherectomy (P=.012), and a trend was shown toward more non-Q- wave myocardial infarction (P=.09). Although the 6-month net minimum l uminal diameter gain was 0.68 mm for atherectomy and 0.50 mm for angio plasty, the restenosis rates were similar, 45.6% for atherectomy and 5 0.5% for angioplasty (P=.491). At 6 months, there was a trend toward d ecreased repeated target-vessel interventions for atherectomy (P=.092) ; in addition, 13.2% of patients treated with atherectomy versus 22.4% of the angioplasty patients (P=.041) required repeated percutaneous i ntervention of the initial target lesion. Conclusions Atherectomy of d e novo vein graft lesions was associated with improved initial angiogr aphic success and luminal diameter but also with increased distal embo lization. There was no difference in 6-month restenosis rates, althoug h primary atherectomy patients tended to require fewer target-vessel r evascularization procedures.