External stenting and disease progression in saphenous vein grafts two years after coronary artery bypass grafting: A multicenter randomized trial
| Autor: | Stephan Jacobs, Ravi De Silva, Matthias Thielmann, Sunil K. Ohri, Mohamad N. Bittar, Rajesh K. Kharbanda, Ivar Friedrich, Amal Bose, George Krasopoulos, Alexandros Paraforos, Daniel Wendt, Marius Berman, Oliver J. Liakopoulos, Cha Rajakaruna, Thomas Schachner, Thomas R. Gehrig, Joseph Zacharias, Umberto Benedetto, Philipp Angleitner, Yulia Gavrilov, Nikolaos Bonaros, Yeong-Hoon Choi, Sigrid Sandner, Terrence John Donovan, David P. Taggart, Gil Bolotin, Keith M. Channon, Hunaid A. Vohra, Leonid Ladyshenskij, Alexander Lipey |
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| Přispěvatelé: | InVESTigators, Benedetto, Umberto (Beitragende*r), Vohra, Hunaid (Beitragende*r), Bittar, Mohamad Nidal (Beitragende*r), Bose, Amal (Beitragende*r), Berman, Marius (Beitragende*r), Kharbanda, Rajesh (Beitragende*r), Paraforos, Alexandros (Beitragende*r), Ladyshenskij, Leonid (Beitragende*r), Bonaros, Nikolaos (Beitragende*r), Schachner, Thomas (Beitragende*r), Sandner, Sigrid (Beitragende*r), Angleitner, Philipp (Beitragende*r), Bolotin, Gil (Beitragende*r), Jacobs, Stephan (Beitragende*r), Thielmann, Matthias Klaus (Beitragende*r), Wendt, Daniel (Beitragende*r), Choi, Yeong-Hoon (Beitragende*r), Liakopoulos, Oliver (Beitragende*r), Ohri, Sunil (Beitragende*r), Lipey, Alexander (Beitragende*r) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Intimal hyperplasia medicine.medical_treatment Medizin Coronary Artery Disease Internal thoracic artery 030204 cardiovascular system & hematology Coronary Angiography law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine.artery Intravascular ultrasound Humans Medicine Saphenous Vein Coronary Artery Bypass Vascular Patency Computed tomography angiography Hyperplasia medicine.diagnostic_test business.industry Stent medicine.disease Surgery Treatment Outcome surgical procedures operative medicine.anatomical_structure 030228 respiratory system Angiography Disease Progression Stents Cardiology and Cardiovascular Medicine business Artery |
| Popis: | Objectives Little data exist regarding the potential of external stents to mitigate long-term disease progression in saphenous vein grafts. We investigated the effect of external stents on the progression of saphenous vein graft disease. Methods A total of 184 patients undergoing isolated coronary artery bypass grafting, using an internal thoracic artery graft and at least 2 additional saphenous vein grafts, were enrolled in 14 European centers. One saphenous vein graft was randomized to an external stent, and 1 nonstented saphenous vein graft served as the control. The primary end point was the saphenous vein graft Fitzgibbon patency scale assessed by angiography, and the secondary end point was saphenous vein graft intimal hyperplasia assessed by intravascular ultrasound in a prespecified subgroup at 2 years. Results Angiography was completed in 128 patients and intravascular ultrasound in the entire prespecified cohort (n = 51) at 2 years. Overall patency rates were similar between stented and nonstented saphenous vein grafts (78.3% vs 82.2%, P = .43). However, the Fitzgibbon patency scale was significantly improved in stented versus nonstented saphenous vein grafts, with Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8% versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P = .03). Fitzgibbon patency scale was inversely related to saphenous vein graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III saphenous vein grafts having an average minimal lumen diameter of 2.62 mm, 1.98 mm, and 1.32 mm, respectively (P < .05). Externally stented saphenous vein grafts also showed significant reductions in mean intimal hyperplasia area (22.5%; P < .001) and thickness (23.5%; P < .001). Conclusions Two years after coronary artery bypass grafting, external stenting improves Fitzgibbon patency scales of saphenous vein grafts and significantly reduces intimal hyperplasia area and thickness. Whether this will eventually lead to improved long-term patency is still unknown. |
| Databáze: | OpenAIRE |
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