Author + information
- Received March 24, 2009
- Revision received May 28, 2009
- Accepted June 25, 2009
- Published online September 1, 2009.
- 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⁎,† and
- Emmanouil S. Brilakis, MD, PhD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Emmanouil S. Brilakis, Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, Texas 75216
Objectives We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS).
Background The mode of SVG failure after stenting has been poorly characterized.
Methods The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients.
Results Binary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non–ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG.
Conclusions SVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure.
- bare-metal stents
- coronary artery bypass graft surgery
- drug-eluting stents
- percutaneous coronary intervention
- saphenous vein grafts
The study was presented at the SCAI's 2009 Annual Scientific Sessions in Las Vegas, Nevada. The SOS trial was funded by a Veteran Affairs VISN-17 Startup Award and by a Clark R. Gregg Grant of the Harris Methodist Foundation to Dr. Brilakis. Dr. de Lemos has received speaker honoraria from Bristol-Myers Squibb/Sanofi-Aventis and consulting income from Johnson and Johnson (<$10,000). Dr. Obel works predominantly with cardiac rhythm devices and has speaker agreements with St. Jude, Medtronic, and Boston Scientific. Dr. Rossen participated in multicenter clinical studies supported by Boston Scientific. Dr. Berger has served as a consultant to PlaCor, Eli Lilly, Accumetrics, The Medicines Company, and Eli Lilly/Daiichi-Sankyo (each for <$10,000) and owns equity in Lumen, Inc. (a company that is developing an embolic protection device) (>$10,000). Dr. Banerjee has served on the Speakers' Bureau for St. Jude Medical Center, Medtronic Corp., and Johnson & Johnson, and has received a research grant from Boston Scientific. Dr. Brilakis has received speaker honoraria from St. Jude.
- Received March 24, 2009.
- Revision received May 28, 2009.
- Accepted June 25, 2009.
- American College of Cardiology Foundation