ACUTE RESULTS AND LONG-TERM OUTCOME OF TRANSLUMINAL EXTRACTION CATHETER ATHERECTOMY FOR SAPHENOUS-VEIN GRAFT STENOSES

Distal embolization of atheroma and thrombus is a major concern when p erforming balloon angioplasty in coronary saphenous vein grafts (SVGs) . The transluminal extraction catheter (TEC) is designed to remove thi s material and may improve the safety of percutaneous treatment of SVG disease. We assessed the acute results and long-term outcome of 67 pa tients (mean age 65.6 +/- 8.1 years; range 47-83 years) who underwent 73 separate TEC atherectomy procedures. Eighty-eight SVG lesions were treated (mean age 8.7 +/- 3.8 years from bypass surgery). Procedural s uccess (<50% final diameter stenosis and absence of major complication s) was obtained in 63 patients (86%). Adjunctive balloon angioplasty a nd/or directional coronary atherectomy was required in 69 of the proce dures (95%). Major complications, occurring in 8 patients (11%), were acute closure in 4 (5%), resulting in Q-wave myocardial infarction in 3 and urgent bypass surgery in 1, and distal embolization in 4 (5%; 1 associated with Q-wave myocardial infarction). Angiographic follow-up was available for 50 patients and restenosis was present in 26 (52%). These data suggest TEC atherectomy can be performed in SVGs with an ac ceptable procedural risk, but restenosis remains a significant limitat ion which will require other strategies to overcome. (C) 1994 Wiley-Li ss, Inc.