Extraction Atherectomy for Recently Occluded Saphenous Vein Grafts: A Retrospective Study

BACKGROUND: Over 300,000 coronary artery bypass operations are performed annually in the U.S., in which saphenous vein grafts remain the most often utilized conduit for myocardial revascularization. Still, the relatively short life-span of reverse saphenous vein grafts (SVG) demands that revascularization techniques be developed for SVG occlusions. Extraction atherectomy (EA) as a pre-treatment to percutaneous transluminal coronary angioplasty (PTCA) may offer advantages to PTCA alone in the treatment of these lesions. While a randomized study would best define the potential advantages of this treatment strategy, a retrospective comparison to historical data may provide some practical insights. PATIENTS AND METHODS: One hundred and six patients treated with EA + PTCA (Group 1) were retrospectively compared to a historical subset of 101 patients treated with PTCA alone (Group 2). Both groups presented with similar clinical profiles with respect to gender, age, graft age, percent diameter stenosis, and location of the target lesion. However, Group 1 had a significantly higher incidence of pre-procedure class III-IV angina than did Group 2 (92.4% vs. 70.3%, p < 0.002), and more recent occlusions. Both groups were compared at one year for the presence of angina, myocardial infarction, and death. Chi-square analysis was performed on the categorical variables. RESULTS: At one-year follow-up, 62.1% of the Group 1 patients were free from cardiac events (defined as absence of angina, myocardial infarction or death) and 58.9% of the Group 2 patients were event free (p = 0.78). A total of 27.0% of the Group 1 patients suffered from class I or Il angina compared to 35.9% of the Group 2 patients (p = 0.40). A total of 10.8% of the Group 1 patients had suffered a myocardial infarction compared to 28.2% of the Group 2 patients (p = 0.06). A total of 2.7% of the Group 1 patients had died compared to 10.5% of the Group 2 patients (p = 0.16). CONCLUSIONS: Patients with recently occluded SVGs (within 3 months) and refractory angina (class III or IV) treated with EA + PTCA have a similar clinical outcome at 1 year follow-up to a historical population treated with PTCA alone, despite the higher incidence of class III-IV angina, and more recent occlusions upon presentation. However, 1-year follow-up results reveal a trend towards less frequent myocardial infarctions for patients treated with EA + PTCA than the historical group of patients treated with PTCA alone (p = 0.06).