Percutaneous Intervention of Acutely Occluded Saphenous Vein Grafts
Objectives. To examine the contemporary acute and long-term outcomes after percutaneous coronary interventions (PCI) of acutely occluded saphenous vein grafts (SVGs).
Background. PCI of acutely thrombosed SVGs carries low success rates. It is unknown whether outcomes have improved with contemporary PCI techniques.
Methods. We reviewed the acute and long-term outcomes of 34 consecutive patients who underwent PCI of 36 acutely occluded SVGs at our institution between 2003 and 2009.
Results. Mean patient age was 70 ± 10 years and 39% had stent thrombosis. Mean SVG age was 14 ± 6 years. SVG PCI was successful in 81%. In 3 patients, PCI of the target vessel native chronic total occlusion (CTO) was attempted after SVG PCI failed and was successful in 2, increasing the overall target myocardial territory revascularization success rate to 86%. Adjunctive PCI techniques were used as follows: mechanical thrombectomy (69%), rheolytic thrombectomy (39%), embolic protection devices (25%) and laser (14%). Stents (61% drug-eluting) were implanted in 78% of the treated lesions. Mean follow up was 2.3 ± 1.9 years. At 1 and 3 years, mortality was 8% and 42%, an acute coronary syndrome occurred in 15% and 41% and repeat coronary revascularization was required in 28% and 38%, respectively.
Conclusions. In this particular population of thrombosed SVG PCIs, a high incidence of stent thrombosis was observed and procedural success rate was 81% with an additional 5% undergoing successful native coronary artery CTO PCI. Patients presenting with thrombosed SVGs were at high risk for recurrent events.
Acute saphenous vein graft (SVG) thrombosis is challenging to treat due to large thrombus burden and high recurrent SVG failure rates. Even if acute percutaneous coronary interventions (PCI) are successful, long-term SVG patency is low. Alternative revascularization approaches, such as PCI of a native coronary artery chronic total occlusion (CTO) have been recently proposed for this patient population. Whether the availability of novel equipment and techniques (such as embolic protection devices, improved thrombectomy devices, drug-eluting stents (DES) and advanced chronic total occlu- sion PCI techniques) has improved acute and long-term outcomes, has received limited study.
The goal of this study was to review the acute and long-term outcomes after PCI of acutely thrombosed SVGs in a contemporary patient cohort.
Abstract and Introduction
Abstract
Objectives. To examine the contemporary acute and long-term outcomes after percutaneous coronary interventions (PCI) of acutely occluded saphenous vein grafts (SVGs).
Background. PCI of acutely thrombosed SVGs carries low success rates. It is unknown whether outcomes have improved with contemporary PCI techniques.
Methods. We reviewed the acute and long-term outcomes of 34 consecutive patients who underwent PCI of 36 acutely occluded SVGs at our institution between 2003 and 2009.
Results. Mean patient age was 70 ± 10 years and 39% had stent thrombosis. Mean SVG age was 14 ± 6 years. SVG PCI was successful in 81%. In 3 patients, PCI of the target vessel native chronic total occlusion (CTO) was attempted after SVG PCI failed and was successful in 2, increasing the overall target myocardial territory revascularization success rate to 86%. Adjunctive PCI techniques were used as follows: mechanical thrombectomy (69%), rheolytic thrombectomy (39%), embolic protection devices (25%) and laser (14%). Stents (61% drug-eluting) were implanted in 78% of the treated lesions. Mean follow up was 2.3 ± 1.9 years. At 1 and 3 years, mortality was 8% and 42%, an acute coronary syndrome occurred in 15% and 41% and repeat coronary revascularization was required in 28% and 38%, respectively.
Conclusions. In this particular population of thrombosed SVG PCIs, a high incidence of stent thrombosis was observed and procedural success rate was 81% with an additional 5% undergoing successful native coronary artery CTO PCI. Patients presenting with thrombosed SVGs were at high risk for recurrent events.
Introduction
Acute saphenous vein graft (SVG) thrombosis is challenging to treat due to large thrombus burden and high recurrent SVG failure rates. Even if acute percutaneous coronary interventions (PCI) are successful, long-term SVG patency is low. Alternative revascularization approaches, such as PCI of a native coronary artery chronic total occlusion (CTO) have been recently proposed for this patient population. Whether the availability of novel equipment and techniques (such as embolic protection devices, improved thrombectomy devices, drug-eluting stents (DES) and advanced chronic total occlu- sion PCI techniques) has improved acute and long-term outcomes, has received limited study.
The goal of this study was to review the acute and long-term outcomes after PCI of acutely thrombosed SVGs in a contemporary patient cohort.
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