Stent implantation of saphenous vein graft aorto-ostial lesions in patients with unstable ischemic syndromes: immediate angiographic results and long-term clinical outcome

Department of Medicine, University of California-Los Angeles School of Medicine.

OBJECTIVES. This study examined the immediate angiographic and long-term clinical results of stenting saphenous vein graft aorto-ostial stenosis at a single center. BACKGROUND. Data on the feasibility, safety and short- and long-term clinical results of stent implantation in aorto-ostial lesions in patients with unstable angina are limited. METHODS. Palmaz or Palmaz-Schatz stents were deployed in 29 patients (mean [+/- SD] age 70 +/- 10 years) with complex (B2 or C) vein graft aorto-ostial lesion morphology. All patients had angina at rest; 23 (79%) had a previous myocardial infarction; and 13 (45%) had two previous bypass operations (mean graft age 9 +/- 5 years). Mean left ventricular ejection fraction was 42 +/- 13%. RESULTS. Thirty-two stents were deployed in 25 new and 4 restenotic aorto-ostial lesions. Ten additional stents were implanted in five patients for eight lesions other than at ostial locations. Stent implantation was successful in all patients. There was no death, Q wave myocardial infarction, bypass surgery or stent thrombosis in the first 30 days. Stenting improved minimal lumen diameter from 0.7 +/- 0.5 mm (95% confidence interval [CI] 0.5 to 0.8) to 3.3 +/- 0.5 mm (CI 3.2 to 3.5) and percent diameter stenosis from 80 +/- 13% (CI 75% to 85%) to 1 +/- 12% (CI -3% to 6%) (p < 0.001 for both variables). Immediate loss from recoil was 0.2 +/- 0.2 mm (CI 0.2 to 0.3), corresponding to a percent recoil of 7 +/- 5% (CI 5% to 9%). Clinical follow-up in all patients at a mean of 11 +/- 8 months revealed that 27 patients (94%) were free of death or myocardial infarction. Bypass surgery and balloon angioplasty were required in one (3%) and two (6%) patients, respectively. In 21 (88%) of the remaining 24 patients, symptoms were lessened by two or more symptom classes. CONCLUSIONS. Palmaz or Palmaz-Schatz stent implantation for saphenous vein graft aorto-ostial stenosis has a high likelihood of immediate success and is associated with a large immediate gain in lumen diameter. Thirty-day and long-term adverse event rates are low. These data suggest that stenting saphenous vein graft aorto-ostial lesions is an acceptable therapeutic option in selected elderly patients with unstable angina and large-diameter vessels.

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