Implantation of paclitaxel-eluting stents in saphenous vein grafts: clinical and angiographic follow-up results from a multicentre study

Abstract

Objective: To define the clinical and angiographic follow-up results after implantation of paclitaxel-eluting stents (PESs) in stenotic saphenous vein grafts (SVGs). Design: Prospective multicentre study. Comparison with a control group. Methods: 60 consecutive patients with 65 lesions located in 65 SVGs (mean (SD) age of vein grafts 11.3 (5.7) years) treated with PES (V-Flex Plus, 2.7 mg/mm 2 paclitaxel, Cook) and 60 patients with 60 SVG lesions treated with bare metal stent (BMS) were included. Lesions had to be ,20 mm in length and in grafts of 2.75-3.5 mm diameter. The 6 month angiographic follow-up was obtained on 51 lesions (79%) of the PES group and on 51 lesions (85%) of the BMS group. Results: Baseline clinical and angiographic characteristics were comparable between both groups. At angiographic follow-up, three vein grafts in the PES group and five vein grafts in the BMS group were occluded. In-stent late lumen loss was lower in PES than in BMS (0.61 (0.81) vs 1.06 (0.72) mm, respectively; p = 0.021). In-stent binary restenosis rates were 12% vs 33%, respectively, (p = 0.012). Linear regression analysis showed BMS to be the only factor with an effect on late lumen loss (p = 0.011). Target-vessel failure rates were 18% in the PES group and 41% in the BMS group (p = 0.019), whereas major adverse cardiac event (MACE) rates at 180 days were 15% and 37%, respectively (p = 0.014). Conclusions: Implantation of non-polymer-based PES in SVG lesions is associated with a lower late lumen loss and restenosis rate than those of BMS. There remains a substantial target-vessel failure rate and MACE rate even at 6 months owing to graft occlusion or new lesions in the graft. D egenerative processes result in occlusion of 50% of saphenous vein grafts (SVGs) within 10 years.

Drug-Eluting or Bare Metal Stents for the Treatment of Saphenous Vein Graft Disease

“…Zotarolimus-eluting stents were used in a minority of patients (8%) in 1 study. 26 Five studies used SES exclusively, 12,20,22,31,33 whereas only 3 studies 13,23,32 reported outcomes with PES for the DES group. When specified, treatment with aspirin was quite homogenous in the studies.…”

“…In the DELAYED RISCC study, 12 clopidogrel was administered for at least 2 months in all patients. Follow-up ranged from 6 months 23,25 to 48 months, 18 for a weighted average follow-up of 22.3 months.…”

“…Periprocedural treatment with clopidogrel was more disparate among eligible studies. In most trials, clopidogrel was prescribed for at least 1 month after BMS placement 13,[17][18][19][21][22][23]25,[27][28][29]36 and for at least 3 18 -20,22,25,28 or 6 months 13,14,17,19,21,23,25,27,28,32,33,36,37 after DES implantation. In the DELAYED RISCC study, 12 clopidogrel was administered for at least 2 months in all patients.…”

Progress in interventional cardiology: challenges for the future

“…However, in cohorts with intermediate and high risk, such as in the context of complex (35), (85), (86), (87), (88), (89) (90), (89), (90) (35), (41), (87), (92), (93) (48), (94), (95), (90), (96), (97) (48), (98), (99), (100), (101), (102), (97) (103), (104) …”

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

“…The efficacy of DES in SVG remains uncertain due to contradictory data that supports lower rates of revascularization with DES [11][12][13][14][15][16][17][18][19]; clinical equivalence to BMS [20][21][22][23][24]; or even an excess of clinical events associated with the use of DES in SVG disease [25][26][27]. Indeed, the DELAYED RRISC trial showed increased mortality in patients treated with DES.…”