TY - JOUR
T1 - A randomized trial of external stenting for saphenous vein grafts in coronary artery bypass grafting
AU - Taggart, David P.
AU - Ben Gal, Yanai
AU - Lees, Belinda
AU - Patel, Niket
AU - Webb, Carolyn
AU - Rehman, Syed M.
AU - Desouza, Anthony
AU - Yadav, Rashmi
AU - De Robertis, Fabio
AU - Dalby, Miles
AU - Banning, Adrian
AU - Channon, Keith M.
AU - Di Mario, Carlo
AU - Orion, Eyal
N1 - Publisher Copyright:
© 2015 The Society of Thoracic Surgeons.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background External stents inhibit saphenous vein graft (SVG) intimal hyperplasia in animal studies. We investigated whether external stenting inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery. Methods Thirty patients with multivessel disease undergoing coronary artery bypass graft surgery were enrolled. In addition to an internal mammary artery graft, each patient received one external stent to a single SVG randomly allocated to either the right or left coronary territories; and one or more nonstented SVG served as the control. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG intimal hyperplasia (mean area) assessed by intravascular ultrasonography at 1 year. Secondary endpoints were SVG failure, ectasia (>50% initial diameter), and overall uniformity as judged by Fitzgibbon classification. Results One-year follow-up angiography was completed in 29 patients (96.6%). All internal mammary artery grafts were patent. Overall SVG failure rates did not differ significantly between the two groups (30% stented versus 28.2% nonstented SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43 SVGs, was significantly reduced in the stented group (4.37 ± 1.40 mm2) versus nonstented group (5.12 ± 1.35 mm2, p = 0.04). In addition, stented SVGs demonstrated marginally significant improvement in lumen uniformity (p = 0.08) and less ectasia (6.7% versus 28.2%, p = 0.05). There was some evidence that ligation of side branches with metallic clips increased SVG failure in the stented group. Conclusions External stenting has the potential to improve SVG lumen uniformity and reduce diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
AB - Background External stents inhibit saphenous vein graft (SVG) intimal hyperplasia in animal studies. We investigated whether external stenting inhibits SVG diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery. Methods Thirty patients with multivessel disease undergoing coronary artery bypass graft surgery were enrolled. In addition to an internal mammary artery graft, each patient received one external stent to a single SVG randomly allocated to either the right or left coronary territories; and one or more nonstented SVG served as the control. Graft patency was confirmed at the end of surgery in all patients. The primary endpoint was SVG intimal hyperplasia (mean area) assessed by intravascular ultrasonography at 1 year. Secondary endpoints were SVG failure, ectasia (>50% initial diameter), and overall uniformity as judged by Fitzgibbon classification. Results One-year follow-up angiography was completed in 29 patients (96.6%). All internal mammary artery grafts were patent. Overall SVG failure rates did not differ significantly between the two groups (30% stented versus 28.2% nonstented SVG, p = 0.55). The SVG mean intimal hyperplasia area, assessed in 43 SVGs, was significantly reduced in the stented group (4.37 ± 1.40 mm2) versus nonstented group (5.12 ± 1.35 mm2, p = 0.04). In addition, stented SVGs demonstrated marginally significant improvement in lumen uniformity (p = 0.08) and less ectasia (6.7% versus 28.2%, p = 0.05). There was some evidence that ligation of side branches with metallic clips increased SVG failure in the stented group. Conclusions External stenting has the potential to improve SVG lumen uniformity and reduce diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.
UR - http://www.scopus.com/inward/record.url?scp=84930929459&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2015.01.060
DO - 10.1016/j.athoracsur.2015.01.060
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C2 - 25886810
AN - SCOPUS:84930929459
SN - 0003-4975
VL - 99
SP - 2039
EP - 2045
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -
