Treatment of aortocoronary graft lesions with graft-stents

Previous controlled trials do not indicate a superiority of the polytetrafluoroethylene membrane-covered stent graft compared with a conventional stent with respect to acute results, restenosis, or clinical event rates. We evaluated the outcome of stenting aortocoronary bypass grafts with polytetrafluoroethylene-covered stent.

The study included 64 patients who had 73 saphenous graft-stent implants. Clinical follow-up was obtained for a median of 6.2 months (1-9 months) for 54 patients.

The mean age of the grafts was 9.2+/-6 years (2-14 years). Procedural success was achieved in 72 of 73 lesions (98.6%). One patient having an anterior Q-wave myocardial infarction died on the second day of procedure. Four patients (6.2%) sustained distal embolization and no reflow. No reflow was overcome after intracoronary administration of nitroglycerine and verapamil in two cases. At follow-up, stable angina pectoris had developed in 10 patients (18%), unstable angina pectoris in two patients (3.7%), acute myocardial infarction in two patients (3.7%), and cardiac death in one patient (1.8%). A total of 45 patients had a coronary angiogram at 6 months of follow-up or earlier, and restenosis at the target site was detected in eight of 53 lesions (15%).

Saphenous graft lesions can be managed successfully with polytetrafluoroethylene-covered stents with acceptable long-term clinical outcome. Further and larger studies are needed to compare conventional stents, polytetrafluoroethylene-covered stents, drug eluting stents, and additional benefit of distal protection devices in these subgroups.