Early experience with a new approach for percutaneous intervention of totally occluded saphenous vein graft: is the flow the best thrombolytic?

Abstract

Aims: Percutaneous coronary intervention (PCI) in the total occlusion of aged saphenous vein grafts (SVGO) is difficult because of inadequate dilatation and distal embolisation. The aim of this study is to report the early experience and clinical outcome of SVGO PCI with a multistaged procedure.

Methods and results: Between January 2003-2006, we treated 20 consecutive patients (pts) admitted with the diagnosis of non-ST segment elevation acute coronary syndromes with culprit lesion located in SVGO. All of them underwent a three stage procedure. Stage 1: recanalisation of graft with undersized balloon; Stage 2: anticoagulation therapy; Stage 3: treatment according to the angiographic result. We obtained vessel recanalisation with TIMI flow 1-2 in 14 pts (70%) by undersized balloon (mean diameter of 1,85±0,43 mm). The mean anticoagulation time was 11±7 days (range 1-20 days). At the Stage 3 all 14 SVG (100%) were patent. A focal lesion was present in 12 pts (86%) treated by stent implantation. In the other two pts (14%) the SVG had no residual lesion. The in-hospital major adverse cardiac event rate was 10%. No death, in-hospital late closure or major bleeding complication occurred. At 2-year follow-up one target vessel revascularisation and one in stent restenosis occurred.

Conclusions: The treatment of SVGO with staged procedure may be used to decrease thrombus burden prior to definitive "short" stent placement and improve the acute and long-term results.