支架置入术后大隐静脉移植物失败的临床表现及血管造影特征：来自SOS（大隐静脉移植物支架置入）试验的见解

Clinical presentation and angiographic characteristics of saphenous vein graft failure after stenting: insights from the SOS (stenting of saphenous vein grafts) trial.

作者信息

Lichtenwalter Christopher, de Lemos James A, Roesle Michele, Obel Owen, Holper Elizabeth M, Haagen Donald, Saeed Bilal, Iturbe Jose Miguel, Shunk Kendrick, Bissett Joseph K, Sachdeva Rajesh, Voudris Vassilios V, Karyofillis Panagiotis, Kar Biswajit, Rossen James, Fasseas Panayotis, Berger Peter, Banerjee Subhash, Brilakis Emmanouil S

机构信息

Veteran Affairs North Texas Healthcare System, Dallas, Texas, USA.

出版信息

JACC Cardiovasc Interv. 2009 Sep;2(9):855-60. doi: 10.1016/j.jcin.2009.06.014.

DOI:10.1016/j.jcin.2009.06.014

PMID:19778774

Abstract

OBJECTIVES

We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS).

BACKGROUND

The mode of SVG failure after stenting has been poorly characterized.

METHODS

The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients.

RESULTS

Binary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non-ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG.

CONCLUSIONS

SVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure.

摘要

目的

我们试图比较使用紫杉醇洗脱支架（PES）与类似裸金属支架（BMS）进行支架置入术后大隐静脉桥（SVG）失败的临床表现和血管造影模式。

背景

支架置入术后SVG失败的模式尚未得到充分描述。

方法

SOS（大隐静脉桥支架置入）试验纳入了80例患者，其88条SVG中有112处病变，这些患者被随机分配至BMS或PES组。83%的患者进行了12个月的血管造影随访。

结果

BMS治疗病变中51%（47处中的24处）发生了二元血管造影再狭窄，而PES治疗病变中为9%（43处中的4处）（p<0.0001）。BMS组失败的21条SVG中有9条（43%）发生了移植物闭塞，PES组失败的4条SVG中有2条（50%）发生了移植物闭塞。支架置入术后SVG失败在24例患者中有10例（42%）表现为急性冠状动脉综合征（其中10例患者中有7例表现为非ST段抬高型急性心肌梗死），9例（37%）患者表现为稳定型心绞痛，5例（21%）患者无症状。在19例（20条移植物）出现有症状移植物失败的患者中，所有13条（100%）次全闭塞的SVG均成功进行了重复SVG血运重建，但在7条闭塞的SVG中只有1条（14%）尝试（且成功）进行了血运重建。另外7例有症状的SVG闭塞患者中有4例（57%）对自身冠状动脉进行了血运重建。