Clinical Presentation and Angiographic Characteristics of Saphenous Vein Graft Failure After StentingInsights From the SOS (Stenting Of Saphenous Vein Grafts) Trial
Christopher Lichtenwalter, MD*, ,
James A. de Lemos, MD*,,
Michele Roesle, RN*,
Owen Obel, MD*,,
Elizabeth M. Holper, MD,
Donald Haagen, RCIS*,
Bilal Saeed, MD ,
Jose Miguel Iturbe, MD, BA*,,
Kendrick Shunk, MD, PhD ,
Joseph K. Bissett, MD||,
Rajesh Sachdeva, MD||,
Vassilios V. Voudris, MD, PhD¶,
Panagiotis Karyofillis, MD¶,
Biswajit Kar, MD#,
James Rossen, MD**,
Panayotis Fasseas, MD,
Peter Berger, MD,
Subhash Banerjee, MD*,,
Emmanouil S. Brilakis, MD, PhD*,,*
* Veteran Affairs North Texas Healthcare System, Dallas, Texas
University of Texas Southwestern Medical Center, Dallas, Texas
Department of Internal Medicine, University of Toledo, Toledo, Ohio
San Francisco VA Medical Center, University of California, San Francisco School of Medicine, San Francisco, California
|| Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas
¶ Onassis Cardiac Surgery Center, Athens, Greece
# Michael E. DeBakey Veterans Affairs Medical Center, Houston Texas
** Iowa City Veteran Affairs Medical Center, Iowa City, Iowa
Medical College of Wisconsin, Milwaukee, Wisconsin
Geisinger Clinic, Danville, Pennsylvania
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Figure 1 SVG Stent Thrombosis in a Patient Randomized to the BMS Arm of the SOS Trial
A 74-year-old man presented with an ostial lesion in a 17-year-old saphenous vein graft (SVG) supplying the right posterior descending artery (arrows, A), which was successfully treated with implantation of a 3.0 x 20 mm Express2 (Boston Scientific, Natick, Massachusetts) bare-metal stent (BMS) (arrows, B) with distal embolic protection with a Filterwire (Boston Scientific). Eleven months after stent implantation the patient presented with a non–ST-segment elevation acute myocardial infarction complicated by ventricular fibrillation and emergency coronary angiography demonstrated ostial SVG occlusion (arrow, C). After implantation of a 3.0 x 15 mm BMS overlapping the distal edge of the prior proximal stent and implantation of a 3.0 x 12 mm BMS in the distal SVG, Thrombolysis in Myocardial Infarction flow grade 3 antegrade SVG was restored (arrows, D).
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Figure 2 SVG Focal In-Stent Restenosis in a Patient Randomized to the BMS Arm of the SOS Trial
A 64-year-old man presented with an ostial lesion in a 28-year old SVG supplying the left anterior descending artery (arrow, A), which was successfully treated with implantation of a 3.0 x 24 mm Express2 (Boston Scientific) BMS (arrows, B) with distal embolic protection with a Filterwire (Boston Scientific). Five months later the patient returned with symptoms of exertional angina and was found to have in-stent restenosis (arrow, C), which was successfully treated with implantation of a 3.0 x 24 mm paclitaxel-eluting stent (arrows, D). Abbreviations as in Figure 1.
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