Comparison of debulking followed by stenting versus stenting alone for saphenous vein graft aortoostial lesions: Immediate and one-year clinical outcomes

OBJECTIVES We compared in-hospital and one-year clinical outcomes in patien ts undergoing debulking followed by stent implantation versus stenting alon e for saphenous vein graft (SVG) aortoostial lesions. BACKGROUND Stent implantation in SVG aortoostial lesions may improve proced ural and late clinical outcomes. However, the impact of debulking before st enting in this complex lesion subset is unknown. METHODS We studied 320 consecutive patients (340 SVG aortoostial lesions) t reated with PaLmaz-Schatz stents. Debulking with excimer laser or atherecto my was performed in 133 patients (139 lesions) before stenting (group I), w hile 187 patients (201 lesions) underwent stent implantation without debulk ing (group II). Procedural success and late clinical outcomes were compared between the groups. RESULTS procedural success (97.6%) was similar between the groups. Procedur al complications were also similar (2.2% for group I and 2.6% for group II) . At one-year follow-up, target lesion revascularization (TLR) was 19.4% fo r group I and 18.2% for group II (p = 0.47). There was no difference in cum ulative death or Q wave myocardial infarction between the groups. Overall c ardiac event-free survival was similar (69% for group I and 68% for group I I). By Cox regression analysis, the independent predictors of late cardiac events were final lumen cross-sectional area (CSA) by intravascular ultraso und (IVUS) (p = 0.001) and restenotic lesions (p = 0.01). Similarly, final NUS lumen CSA (p = 0.0001) and restenotic lesions (p = 0.006) were found to predict TLR at one year. CONCLUSIONS These results suggest that, in most patients with SVG aortoosti al lesions, debulking before stent implantation may not be necessary. (C) 2 000 by the American College of Cardiology.