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Long-term Clinical Results After Stent Implantation in Old Obstructed Saphenous Vein Grafts^*

^* From the Loma Linda University Medical Center, Loma Linda, CA.

Correspondence to: Paulo A. Ribeiro, MD, PhD, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354

Study objective: To assess the long-term clinical outcome of treating patients with coronary artery disease and obstructed saphenous vein grafts (SVGs) with stents deployed by oversized balloon catheters.

Design: The study included 89 of 92 consecutive patients who had 121 SVG stent implants (average, 1.4 stents per patient). We aimed at achieving a negative stenosis using oversized balloons to achieve a catheter to artery ratio of 1.1 : 1, and a 100% follow-up at 24 ± 14 months (range, 0 to 54 months) was achieved.

Patients: As 3 of 92 patients died during hospital admission, the study follow-up population consisted of 89 of 92 patients (mean age, 67 ± 10 years). The age of the SVGs was 10 ± 4 years.

Results: We implanted 118 Palmaz-Schatz and 3 Gianturco-Roubin stents. Procedural success was achieved in 87 of 92 patients (94.5%; < 50% stenosis, and no death, Q-wave acute myocardial infarction, or coronary artery bypass graft [CABG]). Mean SVG stenosis diameter was reduced from 80 ± 13% to -11 ± 12% (p < 0.001) and mean luminal diameter increased from 0.6 ± 0.5 mm to 3.3 ± 0.8 mm (p < 0.001). At follow-up, angina pectoris had developed in 42 of 89 patients (47%), acute myocardial infarction in 12 of 89 patients (14%), reperformed CABG in 12 of 89 patients (14%), cardiac death in 10 of 89 patients (11%), and unrelated death in 6 of 89 patients (7%). Coronary angiography was performed in 37 of 89 patients (42%), with restenosis in 16 of 37 patients (43%) and disease progression at other sites in 11 of 37 patients (30%). Only 25 of 89 patients (28%) experienced event-free survival at follow-up.

Conclusions: Despite high procedural success and excellent angiographic results with oversized balloon catheters, the long-term clinical outcome of SVG stent implantation is suboptimal.

Key Words: coronary artery disease • coronary stenting • saphenous vein grafts

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