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Published on: November 19, 2019
A Randomized Trial of External Stenting for Saphenous Vein Grafts in Coronary Artery Bypass Grafting
David P Taggart1, Yanai Ben Gal2, Belinda Lees3
1Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
Insights
External stenting significantly reduced intimal hyperplasia in saphenous vein grafts (SVGs) one year after coronary artery bypass graft surgery. This innovative approach also improved graft uniformity and reduced ectasia.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Biomedical Engineering
Background:
- Saphenous vein grafts (SVGs) are prone to intimal hyperplasia, a major cause of graft failure after coronary artery bypass graft (CABG) surgery.
- External stents have shown promise in preclinical models for inhibiting SVG intimal hyperplasia.
- This study investigates the efficacy of external stenting in reducing diffuse intimal hyperplasia in SVGs one year post-CABG.
Purpose of the Study:
- To evaluate the impact of external stenting on saphenous vein graft (SVG) diffuse intimal hyperplasia one year after coronary artery bypass graft (CABG) surgery.
- To assess secondary endpoints including SVG failure, ectasia, and lumen uniformity.
Main Methods:
- A randomized trial involving 30 patients undergoing CABG, with one SVG externally stented and others serving as controls.
- Intravascular ultrasonography was used to assess SVG intimal hyperplasia area at one year.
- Graft patency, failure rates, ectasia, and lumen uniformity (Fitzgibbon classification) were evaluated.
Main Results:
- External stenting significantly reduced SVG mean intimal hyperplasia area at one year (4.37 ± 1.40 mm² in stented vs. 5.12 ± 1.35 mm² in non-stented, p=0.04).
- Stented SVGs showed a trend towards improved lumen uniformity (p=0.08) and significantly less ectasia (6.7% vs. 28.2%, p=0.05).
- Overall SVG failure rates did not differ significantly between groups (30% vs. 28.2%, p=0.55).
Conclusions:
- External stenting is a promising strategy to mitigate diffuse intimal hyperplasia in SVGs one year after CABG.
- The technique may improve SVG lumen uniformity and reduce graft ectasia.
- Further research is warranted, considering potential increased SVG failure with side branch ligation in stented grafts.
Background:
External stents inhibit saphenous vein graft (SVG) intimal hyperplasia in animal studies. We investigated whether external stenting inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
Methods:
Thirty patients with multivessel disease undergoing coronary artery bypass graft surgery were enrolled. In addition to an internal mammary artery graft, each patient received one external stent to a single SVG randomly allocated to either the right or left coronary territories; and one or more nonstented SVG served as the control. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG intimal hyperplasia (mean area) assessed by intravascular ultrasonography at 1 year. Secondary endpoints were SVG failure, ectasia (>50% initial diameter), and overall uniformity as judged by Fitzgibbon classification.
Results:
One-year follow-up angiography was completed in 29 patients (96.6%). All internal mammary artery grafts were patent. Overall SVG failure rates did not differ significantly between the two groups (30% stented versus 28.2% nonstented SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43 SVGs, was significantly reduced in the stented group (4.37 ± 1.40 mm(2)) versus nonstented group (5.12 ± 1.35 mm(2), p = 0.04). In addition, stented SVGs demonstrated marginally significant improvement in lumen uniformity (p = 0.08) and less ectasia (6.7% versus 28.2%, p = 0.05). There was some evidence that ligation of side branches with metallic clips increased SVG failure in the stented group.
Conclusions:
External stenting has the potential to improve SVG lumen uniformity and reduce diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
