Placement of “biliary” stents in saphenous vein coronary bypass grafts

Abstract

Angioplasty of coronary saphenous vein grafts has been associated with less favorable results than in native coronary arteries owing to a higher acute complication rate and an increased incidence of restenosis. We placed 16 nonarticulated balloon expandable stainless steel "biliary" stents at the sites of 13 stenotic or occluded aortocoronary saphenous vein graft lesions in 11 patients. All of the lesions were stented successfully. There were no instances of stent thrombosis or stent embolism. The percent diameter stenosis was reduced from 85.5 +/- 14.1% to 3.5 +/- 4.4% (p < .001), and the minimal lumen diameter of the lesion increased from 0.7 +/- 0.7 mm at baseline to 3.7 +/- 0.2 mm (p < .001) after stent placement. We conclude that this noncoronary stent appears to be safe and effective for treating saphenous vein coronary bypass grafts. The high procedural success rate and excellent angiographic results are very encouraging, while the restenosis rates remain to be determined.

Short-Term Outcome of Stent Implantation in Saphenous Vein Grafts

“…3,6,7,11,12 The reason for this relatively high frequency of distal embolization is unclear, but may have been related to the longer lesion length and higher post-dilation pressure (mean: 14.8 atm). In fact, lesion length was associated with the occurrence of distal embolization on multivariate analysis.…”

A novel approach to the placement of Palmaz‐Schatz biliary stents in saphenous vein grafts

“…Recently, large endoluminal stents which can be expanded up to 9 mm diameter have been used in the treatment of vein graft stenoses [9-lo]. There has been a marked increase in utilization of these devices as preliminary data with Palmaz-Schatz stents in vein grafts suggest low restenosis rates [12,15-171. Unlike their coronary counterparts, the biliary Palmaz-Schatz stents do not have a selective delivery system, thus the chance of embolization is increased, and has been reported as high as 8% [8,11]. Without a delivery sheath, the large size of the stents, hand-crimped onto angioplasty balloons, makes advancing the stent through a guiding catheter difficult.…”

Stents and anticoagulation therapy in diseased saphenous vein grafts:to the editor

“…The rationale for intra-SVG thrombolysis must somehow have been related to the assumption of the presence of luminal thrombosis, a condition that seems to be extremely rare in stable SVG patients [3]. However, acute anginal syndromes are known to be associated with a high incidence of luminal thrombosis [4] and in this subset of patients oral anticoagulation may be useful (as mentioned by the authors). As the authors do not provide data on angina functional status (probably the third patient was unstable), their message on the acute benefit of in-loco thrombolysis is unclear and uncertain.…”