A Randomized Trial of External Stenting for Saphenous Vein Grafts in Coronary Artery Bypass Grafting

摘要

Study Design and PopulationProcedure and Follow-UpQuantitative Angiography AnalysisIntravascular UltrasonographyStatistical AnalysisResultsPatients, Procedure, and Follow-UpAngiography, QCA, and IVUSExternal 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.MethodsThirty 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.ResultsOne-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.ConclusionsExternal stenting has the potential to improve SVG lumen uniformity and reduce diffuse intimal hyperplasia 1 year after coronary artery bypass graft surgery.CTSNet classification:23Drs Ben Gal and Orion discloses financial relationships with VEST and Vascular Graft Solutions; and Dr Taggart with Vascular Graft Solutions.Coronary artery bypass graft surgery (CABG) remains the gold standard treatment for patients with multivessel coronary artery disease [