Immediate results and late outcomes after stent implantation in saphenous vein graft lesions: The multicenter U.S. Palmaz-Schatz stent experience

S. Chiu Wong, Donald S. Baim, Richard A. Schatz, Paul S. Teirstein, Spencer B. King, R. Charles Curry, Richard R. Heuser, Stephen G. Ellis, Michael W. Cleman, Paul Overlie, John W. Hirshfeld, Craig M. Walker, Frank Litvack, David Fish, Jeffrey A Brinker, Maurice Buchbinder, Sheldon Goldberg, Chien Chuang Ya Chien Chuang, Martin B. Leon

Research output: Contribution to journalArticle

Abstract

Objectives: This study reports the multicenter registry experience evaluating the safety and efficacy of the Palmaz-Schatz stent in the treatment of saphenous vein graft disease. Background: Saphenous vein graft angioplasty is associated with frequent periprocedural complications and a high frequency of restenosis. Stent implantation has been shown to reduce restenosis, with improved long-term outcomes in the treatment of native coronary artery disease. Preliminary experience with stent placement in the treatment of saphenous vein graft lesions has been favorable. Methods: Twenty U.S. investigator sites enrolled a total of 589 symptomatic patients (624 lesions) for treatment of focal vein graft stenoses between January 1990 and April 1992. Follow-up angiography was performed at 6 months, and the clinical course of all study patients was prospectively collected at regular intervals for up to 12 months. Results: Stent delivery was successful in 98.8% of cases, and the procedural success rate was 97.1%. The lesion diameter stenosis decreased from 82 ± 12% (mean ± SD) before to 6.6 ± 10.2% after treatment. Major in-hospital complications occurred in 17 patients (2.9%); stent thrombosis was found in 8 (1.4%); and major vascular or bleeding complications were noted in 83 (14.3%). Six-month angiographic follow-up revealed an overall restenosis rate (≥50% diameter stenosis) of 29.7%. Multivariate logistic regression analysis indicated that 1) restenotic lesions, 2) smaller reference vessel size, 3) history of diabetes mellitus, and 4) higher percent poststent diameter stenosis were independent predictors of restenosis. The 12-month actuarial event-free survival was 76.3%. Conclusions: Stent implantation in patients with focal saphenous vein graft lesions can be achieved with a high rate of procedural success, acceptable major complications, reduced angiographic restenosis and favorable late clinical outcome compared with historical balloon angioplasty control series. The rigorous anticoagulation regimen after stent placement results in more frequent vascular and other bleeding complications. Future randomized studies comparing standard balloon angioplasty with stent implantation are warranted to properly assess the full impact of stent placement in the treatment of saphenous vein graft lesions.

Original languageEnglish (US)
Pages (from-to)704-712
Number of pages9
JournalJournal of the American College of Cardiology
Volume26
Issue number3
DOIs
StatePublished - 1995

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Saphenous Vein
Stents
Transplants
Pathologic Constriction
Balloon Angioplasty
Blood Vessels
Hemorrhage
Therapeutics
Angioplasty
Multicenter Studies
Disease-Free Survival
Registries
Coronary Artery Disease
Veins
Diabetes Mellitus
Angiography
Thrombosis
Logistic Models
Regression Analysis
Research Personnel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Nursing(all)

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Immediate results and late outcomes after stent implantation in saphenous vein graft lesions : The multicenter U.S. Palmaz-Schatz stent experience. / Wong, S. Chiu; Baim, Donald S.; Schatz, Richard A.; Teirstein, Paul S.; King, Spencer B.; Curry, R. Charles; Heuser, Richard R.; Ellis, Stephen G.; Cleman, Michael W.; Overlie, Paul; Hirshfeld, John W.; Walker, Craig M.; Litvack, Frank; Fish, David; Brinker, Jeffrey A; Buchbinder, Maurice; Goldberg, Sheldon; Ya Chien Chuang, Chien Chuang; Leon, Martin B.

In: Journal of the American College of Cardiology, Vol. 26, No. 3, 1995, p. 704-712.

Research output: Contribution to journalArticle

Wong, SC, Baim, DS, Schatz, RA, Teirstein, PS, King, SB, Curry, RC, Heuser, RR, Ellis, SG, Cleman, MW, Overlie, P, Hirshfeld, JW, Walker, CM, Litvack, F, Fish, D, Brinker, JA, Buchbinder, M, Goldberg, S, Ya Chien Chuang, CC & Leon, MB 1995, 'Immediate results and late outcomes after stent implantation in saphenous vein graft lesions: The multicenter U.S. Palmaz-Schatz stent experience', Journal of the American College of Cardiology, vol. 26, no. 3, pp. 704-712. https://doi.org/10.1016/0735-1097(95)00217-R
Wong, S. Chiu ; Baim, Donald S. ; Schatz, Richard A. ; Teirstein, Paul S. ; King, Spencer B. ; Curry, R. Charles ; Heuser, Richard R. ; Ellis, Stephen G. ; Cleman, Michael W. ; Overlie, Paul ; Hirshfeld, John W. ; Walker, Craig M. ; Litvack, Frank ; Fish, David ; Brinker, Jeffrey A ; Buchbinder, Maurice ; Goldberg, Sheldon ; Ya Chien Chuang, Chien Chuang ; Leon, Martin B. / Immediate results and late outcomes after stent implantation in saphenous vein graft lesions : The multicenter U.S. Palmaz-Schatz stent experience. In: Journal of the American College of Cardiology. 1995 ; Vol. 26, No. 3. pp. 704-712.
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abstract = "Objectives: This study reports the multicenter registry experience evaluating the safety and efficacy of the Palmaz-Schatz stent in the treatment of saphenous vein graft disease. Background: Saphenous vein graft angioplasty is associated with frequent periprocedural complications and a high frequency of restenosis. Stent implantation has been shown to reduce restenosis, with improved long-term outcomes in the treatment of native coronary artery disease. Preliminary experience with stent placement in the treatment of saphenous vein graft lesions has been favorable. Methods: Twenty U.S. investigator sites enrolled a total of 589 symptomatic patients (624 lesions) for treatment of focal vein graft stenoses between January 1990 and April 1992. Follow-up angiography was performed at 6 months, and the clinical course of all study patients was prospectively collected at regular intervals for up to 12 months. Results: Stent delivery was successful in 98.8{\%} of cases, and the procedural success rate was 97.1{\%}. The lesion diameter stenosis decreased from 82 ± 12{\%} (mean ± SD) before to 6.6 ± 10.2{\%} after treatment. Major in-hospital complications occurred in 17 patients (2.9{\%}); stent thrombosis was found in 8 (1.4{\%}); and major vascular or bleeding complications were noted in 83 (14.3{\%}). Six-month angiographic follow-up revealed an overall restenosis rate (≥50{\%} diameter stenosis) of 29.7{\%}. Multivariate logistic regression analysis indicated that 1) restenotic lesions, 2) smaller reference vessel size, 3) history of diabetes mellitus, and 4) higher percent poststent diameter stenosis were independent predictors of restenosis. The 12-month actuarial event-free survival was 76.3{\%}. Conclusions: Stent implantation in patients with focal saphenous vein graft lesions can be achieved with a high rate of procedural success, acceptable major complications, reduced angiographic restenosis and favorable late clinical outcome compared with historical balloon angioplasty control series. The rigorous anticoagulation regimen after stent placement results in more frequent vascular and other bleeding complications. Future randomized studies comparing standard balloon angioplasty with stent implantation are warranted to properly assess the full impact of stent placement in the treatment of saphenous vein graft lesions.",
author = "Wong, {S. Chiu} and Baim, {Donald S.} and Schatz, {Richard A.} and Teirstein, {Paul S.} and King, {Spencer B.} and Curry, {R. Charles} and Heuser, {Richard R.} and Ellis, {Stephen G.} and Cleman, {Michael W.} and Paul Overlie and Hirshfeld, {John W.} and Walker, {Craig M.} and Frank Litvack and David Fish and Brinker, {Jeffrey A} and Maurice Buchbinder and Sheldon Goldberg and {Ya Chien Chuang}, {Chien Chuang} and Leon, {Martin B.}",
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T1 - Immediate results and late outcomes after stent implantation in saphenous vein graft lesions

T2 - The multicenter U.S. Palmaz-Schatz stent experience

AU - Wong, S. Chiu

AU - Baim, Donald S.

AU - Schatz, Richard A.

AU - Teirstein, Paul S.

AU - King, Spencer B.

AU - Curry, R. Charles

AU - Heuser, Richard R.

AU - Ellis, Stephen G.

AU - Cleman, Michael W.

AU - Overlie, Paul

AU - Hirshfeld, John W.

AU - Walker, Craig M.

AU - Litvack, Frank

AU - Fish, David

AU - Brinker, Jeffrey A

AU - Buchbinder, Maurice

AU - Goldberg, Sheldon

AU - Ya Chien Chuang, Chien Chuang

AU - Leon, Martin B.

PY - 1995

Y1 - 1995

N2 - Objectives: This study reports the multicenter registry experience evaluating the safety and efficacy of the Palmaz-Schatz stent in the treatment of saphenous vein graft disease. Background: Saphenous vein graft angioplasty is associated with frequent periprocedural complications and a high frequency of restenosis. Stent implantation has been shown to reduce restenosis, with improved long-term outcomes in the treatment of native coronary artery disease. Preliminary experience with stent placement in the treatment of saphenous vein graft lesions has been favorable. Methods: Twenty U.S. investigator sites enrolled a total of 589 symptomatic patients (624 lesions) for treatment of focal vein graft stenoses between January 1990 and April 1992. Follow-up angiography was performed at 6 months, and the clinical course of all study patients was prospectively collected at regular intervals for up to 12 months. Results: Stent delivery was successful in 98.8% of cases, and the procedural success rate was 97.1%. The lesion diameter stenosis decreased from 82 ± 12% (mean ± SD) before to 6.6 ± 10.2% after treatment. Major in-hospital complications occurred in 17 patients (2.9%); stent thrombosis was found in 8 (1.4%); and major vascular or bleeding complications were noted in 83 (14.3%). Six-month angiographic follow-up revealed an overall restenosis rate (≥50% diameter stenosis) of 29.7%. Multivariate logistic regression analysis indicated that 1) restenotic lesions, 2) smaller reference vessel size, 3) history of diabetes mellitus, and 4) higher percent poststent diameter stenosis were independent predictors of restenosis. The 12-month actuarial event-free survival was 76.3%. Conclusions: Stent implantation in patients with focal saphenous vein graft lesions can be achieved with a high rate of procedural success, acceptable major complications, reduced angiographic restenosis and favorable late clinical outcome compared with historical balloon angioplasty control series. The rigorous anticoagulation regimen after stent placement results in more frequent vascular and other bleeding complications. Future randomized studies comparing standard balloon angioplasty with stent implantation are warranted to properly assess the full impact of stent placement in the treatment of saphenous vein graft lesions.

AB - Objectives: This study reports the multicenter registry experience evaluating the safety and efficacy of the Palmaz-Schatz stent in the treatment of saphenous vein graft disease. Background: Saphenous vein graft angioplasty is associated with frequent periprocedural complications and a high frequency of restenosis. Stent implantation has been shown to reduce restenosis, with improved long-term outcomes in the treatment of native coronary artery disease. Preliminary experience with stent placement in the treatment of saphenous vein graft lesions has been favorable. Methods: Twenty U.S. investigator sites enrolled a total of 589 symptomatic patients (624 lesions) for treatment of focal vein graft stenoses between January 1990 and April 1992. Follow-up angiography was performed at 6 months, and the clinical course of all study patients was prospectively collected at regular intervals for up to 12 months. Results: Stent delivery was successful in 98.8% of cases, and the procedural success rate was 97.1%. The lesion diameter stenosis decreased from 82 ± 12% (mean ± SD) before to 6.6 ± 10.2% after treatment. Major in-hospital complications occurred in 17 patients (2.9%); stent thrombosis was found in 8 (1.4%); and major vascular or bleeding complications were noted in 83 (14.3%). Six-month angiographic follow-up revealed an overall restenosis rate (≥50% diameter stenosis) of 29.7%. Multivariate logistic regression analysis indicated that 1) restenotic lesions, 2) smaller reference vessel size, 3) history of diabetes mellitus, and 4) higher percent poststent diameter stenosis were independent predictors of restenosis. The 12-month actuarial event-free survival was 76.3%. Conclusions: Stent implantation in patients with focal saphenous vein graft lesions can be achieved with a high rate of procedural success, acceptable major complications, reduced angiographic restenosis and favorable late clinical outcome compared with historical balloon angioplasty control series. The rigorous anticoagulation regimen after stent placement results in more frequent vascular and other bleeding complications. Future randomized studies comparing standard balloon angioplasty with stent implantation are warranted to properly assess the full impact of stent placement in the treatment of saphenous vein graft lesions.

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