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CLINICAL STUDIES

Comparison of debulking followed by stenting versus stenting alone for saphenous vein graft aortoostial lesions: immediate and one-year clinical outcomes

^a The Cardiovascular Research Foundation, Washington Hospital Center, Washington, DC, USA

Manuscript received June 28, 1999; revised manuscript received December 3, 1999, accepted January 20, 2000.

Reprint requests and correspondence: Dr. Mun K. Hong, Division of Cardiology, Cornell University-New York Presbyterian Hospital, Starr Pavilion 4, 520 E. 70th St, New York, New York 10021
mkh2003{at}med.cornell.edu

OBJECTIVES

We compared in-hospital and one-year clinical outcomes in patients undergoing debulking followed by stent implantation versus stenting alone for saphenous vein graft (SVG) aortoostial lesions.

BACKGROUND

Stent implantation in SVG aortoostial lesions may improve procedural and late clinical outcomes. However, the impact of debulking before stenting in this complex lesion subset is unknown.

METHODS

We studied 320 consecutive patients (340 SVG aortoostial lesions) treated with Palmaz-Schatz stents. Debulking with excimer laser or atherectomy was performed in 133 patients (139 lesions) before stenting (group I), while 187 patients (201 lesions) underwent stent implantation without debulking (group II). Procedural success and late clinical outcomes were compared between the groups.

RESULTS

Overall procedural success (97.6%) was similar between the groups. Procedural complications were also similar (2.2% for group I and 2.6% for group II). At one-year follow-up, target lesion revascularization (TLR) was 19.4% for group I and 18.2% for group II (p = 0.47). There was no difference in cumulative death or Q wave myocardial infarction between the groups. Overall cardiac event-free survival was similar (69% for group I and 68% for group II). By Cox regression analysis, the independent predictors of late cardiac events were final lumen cross-sectional area (CSA) by intravascular ultrasound (IVUS) (p = 0.001) and restenotic lesions (p = 0.01). Similarly, final IVUS lumen CSA (p = 0.0001) and restenotic lesions (p = 0.006) were found to predict TLR at one year.

CONCLUSIONS

These results suggest that, in most patients with SVG aortoostial lesions, debulking before stent implantation may not be necessary.

Abbreviations and Acronyms   ACT = activated clotting time   CABG = coronary artery bypass surgery   CK-MB = creatinine kinase-MB   CSA = cross-sectional area   ECG = electrocardiogram   EEM = external elastic membrane   IVUS = intravascular ultrasound   MI = myocardial infarction   MLD = minimal lumen diameter   P + M = plaque plus media   PTCA = percutaneous transluminal coronary angioplasty   SVG = saphenous vein graft   TLR = target lesion revascularization

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