Does transluminal extraction coronary atherectomy improve angiographic and clinical outcomes in patients with stenoses in saphenous vein bypass grafts?
TEC atherectomy in saphenous vein bypass grafts is limited by the frequent need for adjunctive balloon angioplasty, high complication rates, and a 69% restenosis rate at 6 months.
BACKGROUND: Transluminal extraction coronary (TEC) atherectomy is a relatively new device that has recently been approved by the Food and Drug Administration. Because of its ability to aspirate clot and atheromatous material, TEC atherectomy may be useful in patients with stenoses in saphenous vein bypass grafts. METHODS AND RESULTS: TEC atherectomy was performed on 158 saphenous vein graft lesions in 146 consecutive patients with a mean age of 65 +/- 8 years (78% men). Clinical indications for atherectomy included stable angina (37%), unstable angina (54%), and postinfarction angina after recent ( or = 20%), and procedural success was achieved in 84% (final diameter stenosis 50%), including 30 lesions (29%) with total occlusion of the original lesion. CONCLUSIONS: In patients with stenoses in saphenous vein bypass grafts, TEC atherectomy is limited by the frequent need for adjunctive balloon angioplasty to achieve adequate lumen enlargement and to manage TEC atherectomy-induced complications. Although the incidence of serious clinical complications is similar to that of other percutaneous interventions in vein grafts, there is a high incidence of restenosis and late vessel occlusion. Prospective randomized studies are needed to determine the best revascularization strategy for high-risk patients with old degenerated vein
Safian et al. (Sat,) studied this question.