THE USE OF GIANTURCO-ROUBIN FLEXIBLE METALLIC CORONARY STENTS IN OLD SAPHENOUS-VEIN GRAFTS - IN-HOSPITAL OUTCOME AND 7-DAY ANGIOGRAPHIC PATENCY

After placement of a Gianturco-Roubin metallic, coiled coronary stent( s) following balloon angioplasty (PTCA), a pre-discharge (7 day) angio gram determined the patency of the old coronary bypass vein graft(s) ( SVG) (greater than or equal to 5 years remote from their last surgery, mean age: 8.5 +/- 1.8 years). Metallic, coiled stents were successful ly deployed in 95/96 (99%) patients within 100/101 (99%) SVGs. The ind ications for deployment were threatened [81 patients (84%)] or acute [ 15 patients (16%)] vein graft closure following PTCA. Intragraft uroki nase infusion was performed in 17 patients (17%) [6 patients with base line occlusions II with abrupt closure post PTCA]. Complications encou ntered 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 mutua lly exclusively, 21 (22%) requiring transfusions, six (6%) cases of ga strointestinal bleeding, six (6%) pseudoaneurysms, five (5%) retroperi toneal haemorrhages and two (2%) cerebrovascular accidents. All patien ts received dipyridamole, aspirin, dextran, and anticoagulation (hepar in 10-20 000 U intra-procedurally); a heparin infusion was continued f or 5 +/- 1 days, despite warfarin administration which attained a ther apeutic prothrombin time (PT) (1.5-2 times control) by 3 +/- 1 days. O ut of the 95 successfully treated patients, six with eight stented gra fts were ineligible for pre-discharge angiography. Of the six, three d ied 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 docum ented in 87/88 (99%) grafts (the one occult SVG closure was successful ly recanalized with thrombolysis). The Gianturco-Roubin metallic, coil ed stent in conjunction with an aggressive anticoagulation regimen eff ectively restored normal flow in old SVGs following complicated balloo n angioplasty. The excellent graft patency, in comparison to that in n ative vessels, may be related to the larger stent size, and/or the vig orous anticoagulation regimen. While the stent was immediately benefic ial, ifs effect upon lesion recurrence, subsequent cardiac events, and survival remains to be seen.