id old vein grafts have a "mucky" appearance. "They are more likely to build up atherosclerotic plaque over long sections and to be filled with cholesterol debris and blood clots. The lesions are less stable, so little particles of plaque can dislodge during the procedure."
In fact, the authors noted that percutaneous coronary intervention (angioplasty) of degenerated saphenous vein grafts is associated with worse outcomes and a high incidence of in-stent restenosis compared with percutaneous intervention of native coronary arteries.
Makkar said the medicated stents appear to provide localized benefits, preventing restenosis at the site of the stent but not in other parts of the bypass graft, which often occurs.
This study analyzed data from 223 consecutive patients who underwent angioplasty to treat diseased saphenous vein grafts that had been in place just under eight years on average. Drug-eluting stents were placed in 139 patients and conventional stents were placed in 84 patients.
During nine months of follow-up, four percent of patients treated with a drug-eluting stent experienced a heart attack, compared to 20 percent of those receiving a bare-metal stent. Also, 10 percent of patients treated with a drug-eluting stent needed a repeat procedure to reopen the vein graft, compared to 37 percent of those treated with a conventional stent. The researchers will continue to follow up to determine if similar results are seen in the long term.
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Contact: Sandy Van
Cedars-Sinai Medical Center
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