Stents Covered by Autologous Venous Grafts: Feasibility and Immediate and Long-Term Results

Christodoulos Stefanadis, MD, FACC, FESC, Konstantinos Toutouzas, MD, Eleftherios Tsiamis, MD, Charalambos Vlachopoulos, MD, Ioannis Kallikazaros, MD, Costas Stratos, MD, Manolis Vavuranakis, MD, FACC, Pavlos Toutouzas, MD, FACC, FESC, Department of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece.

Am Heart J. 2000;139(3) 

In This Article

Results

Sixteen patients ([28.5%] 16 lesions) of the AVGCS group and 36 patients ([31.8%] 38 lesions) of the control group had ACS (Table I). The AVGCS was implanted in all coronary vessels in a variety of lesions (Table II).

In the AVGCS group, the size of the venous graft was appropriate in all cases. The venous graft harvest was accomplished in all patients without complications. The subsequent procedure of covering the stents was successful in all patients and never exceeded 20 minutes. The covered stents were delivered to the culprit lesion without migration or dissection of the vessel. Intracoronary ultrasound examination revealed optimal expansion of the stent in all cases.

There was no evidence of acute stent thrombosis in any patient of the AVGCS group. In 2 patients, a small hematoma was observed at the site of the surgical cutdown in the deltoideopectoral sulcus. Only 1 case of subacute thrombosis occurred (1.78%) in a patient who underwent AVGCS implantation for the treatment of acute myocardial infarction. In the control group, angiographically documented stent acute thrombosis was observed in 3 (2.65%) patients. Acute myocardial infarction developed in 1 of these patients. In these 3 patients, balloon angioplasty was performed at the site of the stent.

During the clinical follow-up, in the AVGCS group, 1 patient died and none of the patients had acute myocardial infarction. In the control group, 2 patients died and 1 patient had acute myocardial infarction. The TVR rate was 12% in the first group and 15% in the latter group (P = not significant [NS]), and the event-free survival was 86% and 81%, respectively (P = NS) (Figure 3). However, in patients with ACS, there was a trend for the TVR rate to be less in the AVGCS group (6.2% vs 21%), although the difference did not reach statistical significance (P = .09) (Table III). Additionally, in this subpopulation, the event-free survival rate was 93% in the AVGCS group and 77% in the control group (P = NS). Moreover, in patients in whom the venous graft had greater thickness (from the anterobrachial region), the event-free survival rate was greater compared with patients in whom the venous graft was harvested from the deltoideopectoral sulcus (94% vs 68% respectively, P < .02). The only variable that was independently associated with clinical events was the anatomic region of harvesting the vein. A relative risk of 5.8 was found in patients in whom a venous graft was obtained from the deltoideopectoral sulcus (95% confidence interval 1.2 to 28.9, P < .03).

Kaplan-Meier curve for event-free survival in study patients. Event-free survival was defined as survival without death, myocardial infarction, and revascularization of target lesion (dotted line, control group); (solid line, AVGCS group).

The MLD at baseline and immediately after the procedure was similar between the 2 groups (Table II). The follow-up MLD was greater in the AVGCS group, although statistical significance was not reached (P = 0.07) (Figure 4). However, in patients with ACS, the MLD was greater in the AVGCS group (P <.03) (Table III and Figure 5). Angiographic restenosis in the AVGCS group was documented in 6 patients (6 lesions [13.3%]) and in 22 patients (25 lesions [21.2%]) in the control group (P = NS). In patients with ACS, angiographic restenosis was not detected in any patient of the AVGCS group (Figure 6). In contrast, angiographic restenosis was observed in 9 lesions (28.1%) in the control group (P < .04). Also, in the AVGCS group, the angiographic results of patients receiving either type A or B AVGCS were similar (P = NS).

Cumulative distribution curve for MLD before (Pre), after (Post), and at follow-up (FU) of study population (blue line, AVGCS group; red line, control group).

Cumulative distribution curve for minimal luminal diameter before (Pre), after (Post), and at follow-up (FU) of patients with ACS (blue line, AVGCS group; red line, control group).

Angiography of left circumflex artery before AVGCS implantation (A), after AVGCS implantation (B), and 3 years after AVGCS implantation (C). Arrows indicate position of endoprosthesis.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....