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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Effect of percutaneous coronary interventions for in-stent restenosis in degenerated saphenous vein grafts without distal embolic protection

Dale T. Ashby, MBBS, PhD, FRACP^*, George Dangas, MD, PhD, FACC^*,*, Eve A. Aymong, MD, Ioannis Iakovou, MD, Frank Kuepper, MD, Roxana Mehran, MD, FACC^*, Gregg W. Stone, MD, FACC^*, Martin B. Leon, MD, FACC^* and Jeffery W. Moses, MD, FACC^*

^* Lenox Hill Heart and Vascular Institute, New York, New York, USA
Cardiovascular Research Foundation, New York, New York, USA

Manuscript received September 17, 2002; revised manuscript received November 15, 2002, accepted November 22, 2002.

^* Reprint requests and correspondence: Dr. George Dangas, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022, USA.
gdangas{at}crf.org

OBJECTIVES: This study was designed to investigate the impact of percutaneous coronary interventions (PCIs) in degenerated saphenous vein grafts (SVGs) without distal embolic protection.

BACKGROUND: Distal embolic protection devices have been shown to reduce the incidence of no reflow/slow flow during PCI of de novo lesions in degenerated SVGs. It is unclear whether PCI of in-stent restenosis (ISR) lesions in degenerated SVGs is associated with no reflow/slow flow and whether distal embolic protection is beneficial in these cases as well.

METHODS: We studied 54 consecutive patients with treated ISR lesions in degenerated SVGs who underwent PCI without distal embolic protection in a single center. Procedural and in-hospital outcomes were examined.

RESULTS: The average age was 71 ± 8 years; 32% of the patients had diabetes. The mean lesion length was 13 ± 6 mm and the procedural success rate was 98% (53/54). Cutting balloon angioplasty was used in 46% (25/54) of cases, and a new stent was inserted in 46% (25/54) of patients. Gamma brachytherapy was performed in 19% (10/54) of patients. During the procedure there were no episodes of no reflow/slow flow, and there were no patients with in-hospital Q-wave or non–Q-wave myocardial infarction. There was one in-hospital noncardiac death.

CONCLUSIONS: In this consecutive series of patients with ISR of degenerated SVGs undergoing PCI without distal protection, there were no episodes of slow flow/no reflow and no procedure-related myocardial infarctions. It appears that distal embolic protection may not be necessary during PCI of ISR lesions in degenerated SVGs.

Abbreviations and Acronyms   CK   creatinine kinase   ECG   electrocardiogram   ISR   in-stent restenosis   MI   myocardial infarction   PCI   percutaneous coronary intervention   SVG   saphenous vein graft   TIMI   Thrombolysis In Myocardial Infarction

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