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J Am Coll Cardiol, 2000; 35:944-948
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Percutaneous revascularization of the internal mammary artery graft: short- and long-term outcomes

Luis Gruberg, MDa,b, George Dangas, MD, PhD, FACC, FESCa,b, Roxana Mehran, MD, FACC, FESCa,b, Mun K. Hong, MD, FACCa,b, Ron Waksman, MD, FACCa,b, Gary S. Mintz, MD, FACCa,b, Kenneth M. Kent, MD, PhD, FACCa,b, Augusto D. Pichard, MD, FACCa,b, Lowell F. Satler, MD, FACCa,b, Alexandra J. Lansky, MDa,b, Gregg W. Stone, MD, FACCa,b and Martin B. Leon, MD, FACCa,b

a Cardiovascular Research Foundation, New York, New York, USA
b Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, DC, USA

Manuscript received August 5, 1999; revised manuscript received October 27, 1999, accepted December 7, 1999.

Reprint requests and correspondence: Dr. George Dangas, Cardiovascular Research Foundation, 6th floor, 55 East 59th Street, New York, NY 10022
gdangas{at}compuserve.com

OBJECTIVES

We evaluated the short- and long-term clinical outcomes after percutaneous revascularization of the internal mammary artery (IMA) graft.

BACKGROUND

Previous reports in a relatively small number of patients have indicated the safety of balloon angioplasty for the treatment of stenoses in the IMA graft. However, the use of alternative interventional techniques and their long-term results have not yet been evaluated.

METHODS

We analyzed the in-hospital and one-year clinical outcomes of 174 consecutive patients who underwent percutaneous revascularization of 202 lesions located in the IMA graft, by either balloon angioplasty or stenting.

RESULTS

Anastomotic lesions were evident in 128 cases (63%), and they were more commonly treated with balloon angioplasty (116/128, 91%), whereas lesions located at the ostium (n = 16, 8%) were more frequently treated with stents (11/16, 69%). Procedural success was 97% with excellent in-hospital outcome: 0.6% mortality rate, no Q-wave myocardial infarction (MI) and 0.6% rate of urgent bypass surgery. Cumulative one-year rates were: mortality 4.4%, MI 2.9% and target lesion revascularization (TLR) 7.4%.

CONCLUSIONS

Revascularization of the IMA graft can be performed safely, with high procedural success and a low rate of in-hospital complications. Long-term follow-up showed very low TLR rate.

Abbreviations and Acronyms
  CABG = coronary artery bypass graft
  CCS = Canadian Cardiovascular Society
  CK = creatine kinase
  IMA = internal mammary artery
  MI = myocardial infarction
  MLD = minimal lumen diameter
  PTA = percutaneous transluminal angioplasty
  TIMI = Thrombolysis in Myocardial Infarction
  TLR = target lesion revascularization




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[Abstract] [PDF]


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