NEW YORK (Reuters Health) – The use of undersized drug-eluting stents for saphenous vein graft lesions may reduce the long-term incidence of emboli and enzyme elevations without increasing the risk of cardiovascular events.

This conclusion is reported by Dr. Ron Waksman, from Seoul Medical Center, Korea, and colleagues in the November 14 online issue of the American Journal of Cardiology.

Percutaneous cardiac interventions (PCI) for saphenous vein graft stenoses have poorer short- and long-term outcomes compared to PCI of native coronary arteries, particularly with regard to distal embolization, no-reflow, and occasional significant myocardial infarction, the authors note.

Their current study compared the efficacy of undersize versus normal-size stents on clinical outcomes of 209 patients with saphenous vein graft lesions who had successful intravascular ultrasound-guided PCI with placement of drug-eluting (sirolimus or paclitaxel) stents.

Patients were divided into three groups based on the ratio of the stent diameter to the average intravascular ultrasound reference lumen diameter: Group 1, 1.0 (n = 67). Mean ages in the three groups ranged from 68 to 71 years, and roughly half the subjects were male.

There was no significant difference in the incidence of stent malapposition among the 3 groups. However, plaque intrusion into the stent occurred least often in group 1 (n = 15, 21%) and most often in group 3 (n = 35, 52%).

Plaque intrusion area and volume followed a similar pattern. Both were correlated with the ratio of the stent diameter to the average lumen diameter (r – 0.28, p 3 times normal was 6% in group I, 9% in group II, and 19% in group III (p = 0.025).

However, the 1-year major adverse cardiac event rates – target lesion and target vessel revascularization, myocardial infarction, death – did not differ significantly among groups.

In patients who need stents for a saphenous vein graft lesion, “These results suggest that a less-aggressive PCI technique with relatively small drug-eluting stents…might help to avoid distal embolization without an increase in events during long-term follow-up,” the investigators write.

Because this was a single-center study, the authors conclude that “these observational data need to be corroborated by a large randomized trial before final conclusions can be reached.”

Reference:
Am J Cardiol 2010.