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Transluminal atherectomy of saphenous vein aortocoronary bypass grafts
U P Kaufmann1, K N Garratt, R E Vlietstra
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Transluminal atherectomy effectively treated stenosed saphenous vein bypass grafts, showing good immediate results. However, follow-up revealed a high rate of restenosis, limiting long-term efficacy.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Saphenous vein graft (SVG) stenosis poses challenges due to high complication and restenosis rates.
- Angioplasty for SVG lesions often yields unsatisfactory outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of transluminal coronary atherectomy (TCA) for stenosed SVG lesions.
- To assess immediate and short-term outcomes of TCA in SVG interventions.
Main Methods:
- TCA was performed on 15 stenosed SVG lesions in 14 patients.
- Stenosis severity was assessed before and after the procedure.
- Complications, angiographic restenosis, and clinical outcomes were evaluated post-procedure.
Main Results:
- Successful atherectomy was achieved in 13 of 14 patients (93%).
- Mean stenosis diameter decreased from 85% to 15%.
- Minor complications included atheromatous embolus, air embolism, and transient thrombosis with myocardial infarction in one patient. At 4-6 months, 5 of 8 patients showed restenosis, while 3 had patent grafts. Clinical follow-up at 3 months showed 2 asymptomatic patients and 2 with angina.
Conclusions:
- TCA offers excellent immediate results and a low incidence of major complications for stenosed SVG lesions.
- Preliminary follow-up indicates a significant rate of restenosis, questioning the long-term benefit of TCA in this setting.
Abstract:
Angioplasty of stenotic saphenous vein aortocoronary bypass grafts is often unsatisfactory because of the relatively high incidence of acute complications and restenosis. During an initial evaluation of transluminal coronary atherectomy, 14 patients had atherectomy of saphenous vein graft lesions (15 grafts). Atherectomy was successful in 13 of 14 patients, decreasing the mean diameter of stenosis from 85 to 15%. In 1 patient, the lesion could not be crossed by the atherectomy device. The following 3 minor complications occurred: 1 embolus of atheromatous material; 1 air embolism; and 1 transient thrombosis leading to subendocardial myocardial infarction. Of the 14 patients, 8 underwent angiography 4 to 6 months after atherectomy; 5 patients had restenosis and 3 had widely patent grafts. Four other patients were clinically evaluated at 3 months after atherectomy. Two were asymptomatic, 1 had class II angina and 1 had class III angina. Transluminal atherectomy achieved excellent immediate results with a low incidence of major complications in the treatment of stenosed saphenous vein bypass grafts. However, preliminary follow-up results suggest a high incidence of restenosis.