Results of saphenous vein graft stent implantation: Single center results from use of oversized balloon catheters

The results and complications of a single-center experience of stent implan tation in old saphenous vein grafts (SVGs) need to be defined. The authors studied their initial consecutive 92 patients (125 stents, 1.4 stents/per p atient) with a mean age of 67 +/- 9 years. The patients' mean saphenous vei n graft (SVG) age was 10 +/- 4 years, and the mean left ventricular ejectio n fraction was 46% +/- 15. Patient population included unstable angina (65% ), stable angina (10%), myocardial infarction (21%), and silent ischemia (4 %). The authors implanted 122 Palmaz-Schatz/biliary and three Gianturco-Rou bin stents. They aimed at a balloon-artery ratio of 1.1/1.0. Procedural suc cess, defined as stent deployment with <50% stenosis without death/Q-wave m yocardial infarction/coronary artery bypass grafting (MI/CABG) was 95%. The mean luminal diameter (MLD) increased from 0.6 +/- 0.5 to 3.3 +/- 0.8 mm ( p<0.001) and mean SVG stenosis diameter was decreased from 80% +/- 14 to -1 0% +/- 11 (p<0.001). Angiographic SVG lesions exhibited thrombus (17%), ulc eration (38%), and plaque rupture (28%). Sixty-two patients were treated wi th warfarin and aspirin and 30 with ticlid and aspirin. Complications inclu ded death in three patients (3.3%) who sustained subacute stent thrombosis, and two of three had Q-wave MI. Distal embolization occurred in seven pati ents (8%); six of seven sustained a non Q-wave acute myocardial infarction (AMI); and one of seven a Q-wave MI. Eight (9)) patients had major groin he matoma, two had pseudoaneurysm (2.2%), one had arteriovenous (A-V) fistula (1.1%), two had vascular surgery (2.2%), nine had blood transfusion (9.8%), and three had stent migration (3.3%). Single-center experience with stents in SVGs indicates a highly successful procedural and angiographic immediat e result. However, it was complicated by significant risk of non Q-wave MI due to distal coronary embolization which may affect prognosis.