Abstract 3345: Efficacy of Relatively Small Drug-Eluting Stents on Clinical Results of Saphenous Vein Graft Lesion Interventions
We sought to determine the efficacy of relatively small drug-eluting stent (DES) implantation on clinical results after percutaneous coronary intervention (PCI) for saphenous vein graft (SVG) lesions. Using intravascular ultrasound (IVUS) guidance, 209 SVG lesions were treated by DES (153 sirolimus-eluting and 56 paclitaxel-eluting stent). Lesions were divided into three groups according to the ratio of stent diameter to average IVUS reference lumen diameter: Group I <0.89, Group II 0.9–1.0, and Group III >1.0. Angiographic no-reflow was defined as TIMI flow grade 0, 1, and 2. Plaque prolapse (PP) was defined as tissue protrusion through the stent struts. Stent malapposition was defined as one or more stent struts clearly separated from the vessel wall with evidence of blood speckles behind the strut.
Results: There was no significant difference in the use of distal protection devices among three groups (Group I: 44%, Group II: 35%, and Group III: 36%, p=0.5). There were no significant differences in the incidence of no-reflow and stent malapposition among three groups. However, PP was most frequently observed and maximum PP area and PP volume were largest in Group III (Table⇓); and PP area and volume correlated with the ratio of stent diameter to average IVUS reference lumen diameter (r=0.278, p<0.001, and r=0.283, p<0.001, respectively). The highest frequency of creatine kinase (CK)-MB elevation >3 times normal was seen in Group III; and this degree of CK-MB elevation was more frequently observed in lesions with PP compared to lesions without PP (18.8% vs. 6.2%, p=0.005). There were no significant differences in one-year target lesion or target vessel revascularization among three groups (Table⇓).
Conclusions: The use of smaller DES to treat pts with SVG lesions is associated with a reduction in frequency of post-PCI CK-MB elevation and a trend toward reduced no-reflow, presumably because of lesser degrees of plaque prolapse, with no increase in one year events.