Comparative analysis of saphenous vein bypass vs. native coronary artery balloon angioplasty: Technical differences and angiographic response

Autor: Sanh Bui, Brian P. Kimball
Rok vydání: 1995
Předmět:
Zdroj: Catheterization and Cardiovascular Diagnosis. 34:293-299
ISSN: 1097-0304
0098-6569
Popis: To evaluate technical differences and angiographic response of saphenous vein bypass graft angioplasty in comparison to native coronary arteries, we retrospectively analyzed 54 patients undergoing this procedure at The Toronto Hospital between February 1988 and May 1993. These subjects were temporally matched to a cohort of successful native coronary angioplasties, with comparison of technical parameters, pre-existing qualitative/quantitative (Cardiac Measurement System) stenotic morphology, and angiographic response; including changes in minimum lumen diameter. Saphenous bypass graft angioplasty utilized larger balloons (CABG, 3.27 ± 0.65 vs. native, 2.90 ± 0.37 mm, P < .05), and higher inflation pressures (CABG, 10.1 ±3.7 vs. native, 8.8 ± 2.5 atm, P < .05), although in a relative sense, balloon/artery ratios were similar (CABG, 1.09 ± 0.20 vs. native, 1.03 ± 0.15, pNS). Pre-procedural bypass graft lesions were more complex, with more frequent ACC/AHA type B1 lesions [CABG, 24/54 (44%) vs. native, 16/54 (30%), P < .05] and luminal thrombus [CABG, 17/54 (31%) vs. native, 6/54(11%), P < .05]. Quantitative angiography revealed larger “reference” diameters within saphenous veins (CABG, 3.41 ± 0.76 vs. native, 3.04 ± 0.51 mm, P < .05), although minimum lumen diameter was less severe (CABG, 0.83 ± 0.41 vs. native, 0.77 ± 0.36, P < .05). In terms of balloon angioplasty response, greater improvemnet in luminal diameter was seen in bypass graft lesions (CABG, 1.55 ± 0.53 vs. native, 1.32 ± 0.44 mm, P < .05), with the largest changes within the “body” of the saphenous vein (ostial, 1.53 ± 0.37; body, 1.68 ± 0.50; anastomosis, 1.37 ± 0.57 mm). In conclusion, technical differences do exist during the performance of balloon angioplasty in degenerative saphenous vein bypass grafts, often dictated by morphologically complex lesions. Bypass grafts demonstrate a larger intrinsic lumen, although preexisting stenoses tend to be less severe, with greater improvement in minimum lumen diameter. Some of these differences may be attributable to intrinsic differences in the compliance characteristics of saphenous vein bypass grafts and to differing characteristics of the relatively accelerated atherosclerosis.
Databáze: OpenAIRE
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