Stent implantation of saphenous vein graft aorto-ostial lesions in patients with unstable ischemic syndromes: Immediate angiographic results and long-term clinical outcome

Objectives.: This study examined the immediate angiographic and long-term clinical results of stenting saphenous vein graft aorto-ostial stenosis at a single center. Background.: Data on the feasibility, safety and short- and long-term clinical results of stent implantation in aorto-ostial lesions in patients with unstable angina are limited. Methods.: Palmaz or Palmaz-Schatz stents were deployed in 29 patients (mean [±SD] age 70 ± 10 years) with complex (B2 or C) vein graft aorto-ostial lesion morphology. All patients had angina at rest; 23 (79%) had a previous myocardial infarction; and 13 (45%) had two previous bypass operations (mean graft age 9 ± 5 years). Mean left ventricular ejection fraction was 42 ± 13%. Results.: Thirty-two stents were deployed in 25 new and 4 restenotic aorto-ostial lesions. Ten additional stents were implanted in five patients for eight lesions other than at ostial locations. Stent implantation was successful in all patients. There was no death, Q wave myocardial infarction, bypass surgery or stent thrombosis in the first 30 days. Stenting improved minimal lumen diameter from 0.7 ± 0.5 mm (95% confidence interval [CI] 0.5 to 0.8) to 3.3 ± 0.5 mm (CI 3.2 to 3.5) and percent diameter stenosis from 80 ± 13% (CI 75% to 85%) to 1 ± 12% (CI -3% to 6%) (p < 0.001 for both variables). Immediate loss from recoil was 0.2 ± 0.2 mm (CI 0.2 to 0.3), corresponding to a percent recoil of 7 ± 5% (CI 5% to 9%). Clinical follow-up in all patients at a mean of 11 ± 8 months revealed that 27 patients (94%) were free of death or myocardial infarction. Bypass surgery and balloon angioplasty were required in one (3%) and two (6%) patients, respectively. In 21 (88%) of the remaining 24 patients, symptoms were lessened by two or more symptom classes. Conclusions.: Palmaz or Palmaz-Schatz stent implantation for saphenous vein graft aorto-ostial stenosis has a high likelihood of immediate success and is associated with a large immediate gain in lumen diameter. Thirty-day and long-term adverse event rates are low. These data suggest that stenting saphenous vein graft aorto-ostial lesions is an acceptable therapeutic option in selected elderly patients with unstable angina and large-diameter vessels.