Costa Marco, Angiolillo Dominick J, Teirstein Paul, Gilmore Paul, Leon Martin, Moses Jeffrey, Yakubov Steven, Carter Andrew, Fischell Tim, Zenni Martin, Bass Theodore
Department of Cardiology, University of Florida, Shands, Jacksonville, FL 32209, USA.
J Invasive Cardiol. 2005 Aug;17(8):396-8.
Graft disease remains a therapeutic challenge. Procedural complications and unsatisfactory patency rates are realized with both percutaneous intervention and repeat coronary artery bypass graft (CABG) surgery. The efficacy of sirolimus-eluting stents (SES) for the treatment of de novo coronary artery disease has been established, but the use of this technology to treat bypass graft disease remains undefined. The aim of this study was to evaluate the safety and feasibility of SES to treat patients with high-risk bypass graft disease.
The compassionate use of SES (SECURE) study included patients with recurrent coronary disease and no acceptable alternative available treatment, including brachytherapy or CABG. Outcomes from 76 patients (n = 94 lesions) with graft lesions treated with SES in the U.S. were compared with the outcomes of 176 patients (n = 311 lesions) with only native vessels. IVUS follow-up was performed at 8 months in 14 patients with graft SES treatment.
In-hospital outcomes were similar between both groups, with 99% of patients discharged without adverse events. The incidence of target vessel failure including death, MI, and TVR at 12 months in the bypass graft group (55.3%) was similar to that observed in the native vessel group (45.5%, p = 0.17). Intimal hyperplasia (IH) measured by IVUS was 11.8 +/- 16.5%; 50% of patients with graft SES had < 1% IH at 8 months.
Implantation of SES in high-risk patients with recurrent bypass graft disease is feasible. SES represents a future.
移植物疾病仍然是一个治疗挑战。经皮介入治疗和再次冠状动脉旁路移植术（CABG）手术都存在手术并发症和不理想的通畅率。西罗莫司洗脱支架（SES）治疗新发冠状动脉疾病的疗效已得到证实，但该技术用于治疗旁路移植血管疾病的情况仍不明确。本研究的目的是评估SES治疗高危旁路移植血管疾病患者的安全性和可行性。
SES的同情使用（SECURE）研究纳入了患有复发性冠心病且没有可接受的替代治疗方法（包括近距离放射治疗或CABG）的患者。将美国76例（94处病变）接受SES治疗的移植血管病变患者的结果与176例（311处病变）仅患有自身血管病变的患者的结果进行比较。对14例接受移植血管SES治疗的患者在8个月时进行血管内超声（IVUS）随访。
两组的住院结局相似，99%的患者出院时无不良事件。旁路移植血管组12个月时包括死亡、心肌梗死和靶血管再次干预（TVR）的靶血管失败发生率（55.3%）与自身血管组观察到的发生率（45.5%，p = 0.17）相似。通过IVUS测量的内膜增生（IH）为11.8±16.5%；50%接受移植血管SES治疗的患者在8个月时IH<1%。
在高危复发性旁路移植血管疾病患者中植入SES是可行的。SES代表着一个未来。
