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Percutaneous treatment of saphenous vein grafts- a real life analysis
Session:
Sessão de Posters 29 - Intervenção coronária percutânea
Speaker:
Isabel Cruz
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Isabel Cruz; Isabel Cruz; Rafaela Lopes; Bruno Bragança; Inês Campos; Rui Santos; Lino Santos; Alberto Rodrigues; Pedro Braga; Aurora Andrade; Ricardo Fontes-Carvalho
Abstract
<p><strong>Introduction</strong><br /> Saphenous vein grafts (SVGs) are frequently used as conduits during surgical revascularization of coronary arteries but present a poor long-term patency due to the accelerated atherosclerosis and intimal fibrosis. Percutaneous coronary intervention (PCI) of SVGs has been associated with a worse outcome compared with native coronary vessels, due to higher rates of in-stent restenosis, target vessel revascularization (TVR), myocardial infarction (MI), and death. It has been advocated that direct stenting may trap debris as well as decrease distal embolization and, in this way, reduce the occurrence of adverse cardiovascular events. <br /> <br /> <strong>Methods</strong><br /> Unicentric, retrospective analysis of consecutive patients (pts) submitted to coronary stenting in SVGs from January 2015 to December 2023. Pts were characterized regarding baseline characteristics (sex, age and comorbidities). Clinical, angiographic, procedure-related variables and incidence of adverse events (all-cause mortality, cardiovascular mortality, MI, and TVR) were evaluated.<br /> <br /> <strong>Results</strong><br /> A total of 56 pts were included in the analysis (mean age of 73.4±8.8 years and 76.8% male). Regarding baseline characteristics, 66.1% of pts were hypertensive, 64.3% presented dyslipidaemia, 53.6% were diabetic, and 21.4% presented previous PCI. The most frequent indication for SVGs PCI was acute coronary syndrome (60.7%), followed by chronic coronary syndrome refractory to medical therapy (30.4%) and de novo heart failure (3.6%). The mean time of coronary revascularization was 14.5±6.8 years and the mean time of follow-up was 4.8±2.2 years. The receptor vessel was circumflex/marginal obtuse artery in 50.5% cases, right coronary artery/posterior descending artery in 41.1% cases and left anterior descending artery/diagonal branch in 8.9% cases. Most pts were treated with drug-eluting stents (92.9%), of which 60.7% were submitted to pre-dilation and 33.9% to direct stenting. No-reflow was observed in 5.4% of pts, while procedure success was observed in 85.7% of the cases. Regarding late follow-up, the composite endpoint of all-cause mortality, acute myocardial infarction and target vessel revascularization was observed in 37.5% of pts. The individual endpoints of all-cause mortality, AMI and TVR were identified in 19.6%, 7.1% and 8.9% of pts, respectively. Comparing the strategy of treatment with pre-dilation versus direct stenting no statistically significant differences were identified regarding the composite (p=.241) and individual endpoints (AMI, p=.524; TVR, p=.079; all-cause mortality, p=.862). <br /> <br /> <strong>Conclusion</strong><br /> In this cohort, patients treated by PCI of lesions in SVGs presented a high rate of mid-term adverse events. No differences were observed regarding long-term follow-up in the stent-only group versus the balloon-stent group.<br /> </p>
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