Assessing a strategy of initial stand-alone extractional atherectomy followed by staged stent placement in degenerated saphenous vein graft lesions

To assess whether a staged strategy (initial stand alone transluminal extra ction atherectomy and coumadin therapy followed by stenting six weeks later ) could reduce ischemic complications in degenerated saphenous vein graft ( SVG) interventions, we studied 72 patients undergoing percutaneous interven tions of degenerated SVG. Patients were divided into two groups; 28 were tr eated with a staged strategy (group I) and 44 with similar lesion character istics were treated with a definitive initial procedure with transluminal e xtraction atherectomy +/- adjunctive balloon angioplasty and stenting (grou p II). Procedural success, major in-hospital complications (death, Q-wave m yocardial infarction, and emergent coronary bypass surgery), and incidence of distal embolization were compared between the 2 groups. Procedural succe ss was lower (92% vs 100%, p = 0.14) and major in-hospital complications we re higher (0% vs 11%, p = 0.14) in group II. Distal embolization occurred i n 11% of the patients in group I compared with 23% of the patients in group II (p = 0.19). At 6 week follow-up (group I), 9 patients (33%) had negativ e symptoms, 11 (41%) underwent stent implantation, 3 (11%) did not require any further therapy (without significant stenosis), and 4 (14%) had total o cclusions. We therefore conclude that this staged strategy in degenerated S VG appears to reduce distal embolization but most importantly avoids major in-hospital complications, including any deaths either at the time of initi al procedure or during the 6-week follow-up period. (C)2000 by Excerpta Med ica, Inc.