Document Detail


Can direct stenting in selected saphenous vein graft lesions be considered an alternative to percutaneous intervention with a distal protection device?
MedLine Citation:
PMID:  19006243     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Distal embolization during percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) lesions is associated with a high rate of myonecrosis. Although direct stenting (DS) is feasible with less catheter manipulations, its ability to prevent distal embolization in SVG lesions compared with distal protection devices (DPD) is unknown. METHODS: The study included 188 SVG lesions subjected to PCI, 101 patients with 101 lesions treated with DPD, and 87 patients with 87 lesions by DS without DPD. Major adverse cardiovascular events (MACE) in-hospital and at 30 days were compared. RESULTS: Baseline characteristics were comparable, except for higher frequencies of unstable angina (53% vs. 67%, P = 0.045) and prior myocardial infarction (38% vs. 53%, P = 0.07) in the DS group. There was no difference in lesion type aside from more restenotic lesions in the DS group (7% vs. 16%, P = 0.047). Drug-eluting stent deployment was similar. Stent length in the DPD group (22.8 +/- 7.2 mm) was significantly longer than that in the DS group (17.6 +/- 8.0 mm, P < 0.001). Although maximum creatine kinase (CK)-MB value in the DPD group (2.5 +/- 5.8 ng/ml) was significantly larger than in the DS group (1.3 +/- 1.5 ng/ml, P = 0.039), the frequency of CK-MB rise >2 times the upper limit of normal did not differ (11% vs. 6%, P = 0.2). There were no differences in MACE rates in-hospital and at 30 days. By multivariate analysis, neither DPD nor DS was a significant predictor for maximum CK-MB value. CONCLUSION: DS should be considered an alternative treatment to PCI with DPD for selected SVG lesions.
Authors:
Teruo Okabe; Joseph Lindsay; Rebecca Torguson; Daniel H Steinberg; Probal Roy; Tina L Pinto Slottow; Kimberly Kaneshige; Zhenyi Xue; Lowell F Satler; Kenneth M Kent; Augusto D Pichard; Ron Waksman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  72     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  799-803     Citation Subset:  IM    
Copyright Information:
(c) 2008 Wiley-Liss, Inc.
Affiliation:
Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  instrumentation*
Cardiovascular Diseases / etiology
Coronary Angiography
Embolism / etiology,  prevention & control*
Female
Filtration / instrumentation*
Graft Occlusion, Vascular / etiology,  physiopathology,  radiography,  therapy*
Humans
Logistic Models
Male
Prosthesis Design
Registries
Retrospective Studies
Risk Assessment
Saphenous Vein / physiopathology,  radiography,  transplantation*
Stents*
Time Factors
Treatment Outcome
Vascular Patency
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2008 Nov 15;72(6):804-5   [PMID:  19009627 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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