Adjunctive abciximab improves outcomes during recanalization of totally occluded saphenous vein grafts using transluminal extraction atherectomy

Degenerative disease of aortocoronary saphenous vein grafts is a major caus e of late morbidity and mortality in patients after coronary bypass surgery , We previously described a technique for recanalization of totally occlude d grafts using extraction atherectomy (TEC) as a primary modality While suc cess was comparable to overnight urokinase, distal embolization, no-reflow, and non-a myocardial infarction were common. Recently, abciximab has been used adjunctively in angioplasty and stenting with a reduced incidence of p eriprocedural complications. In order to determine whether abciximab can re duce the incidence of distal embolization, no-reflow, and myocardial infarc tion during TEC in totally occluded saphenous Vein grafts, we compared pati ents treated with adjunctive abciximab with control subjects not receiving the drug. Male patients with previous coronary bypass surgery, class III-IV angina, and totally occluded saphenous vein grafts serving a Vascular terr itory with ischemia not approachable by standard catheter-based techniques underwent TEC with or without adjunctive abciximab. Recanalization of the g raft was achieved in 8/10 (80%) of subjects without abciximab, but complete success was achieved in only 5/10 (50%). In contrast, ail procedures in th e abciximab group were completely successful, without embolization or no-re flow Our results suggest that TEC with adjunctive abciximab may be a highly effective approach for management of totally occluded saphenous Vein graft s. Published 1999 Wiley-Liss, Inc.(dagger)