Effect of percutaneous coronary interventions for in-stent restenosis in degenerated saphenous vein grafts without distal embolic protection

OBJECTIVES This study was designed to investigate the impact of percutaneous coronary interventions (PCIs) in degenerated saphenous vein grafts (SVGS) without distal embolic protection. BACKGROUND Distal embolic protection devices have been shown to reduce the incidence of no reflow/slow flow during PCI of de novo lesions in degenerated SVGs. It is unclear whether PCI of in-stent restenosis (ISR) lesions in degenerated SVGS is associated with no reflow/slow flow and whether distal embolic protection is beneficial in these cases as well. METHODS We studied 54 consecutive patients with treated ISR lesions in degenerated SVGS who underwent PCI without distal embolic protection in a single center. Procedural and in-hospital outcomes were examined. RESULTS The average age was 71 +/- 8 years; 32% of the patients had diabetes. The mean lesion length was 13 +/- 6 mm and the procedural success rate was 98% (53/54). Cutting balloon angioplasty was used in 46% (25/54) of cases, and a new stent was inserted in 46% (25/54) of patients. Gamma brachytherapy was performed in 19% (10/54) of patients. During the procedure there were no episodes of no reflow/slow flow, and there were no patients with in-hospital Qwave or non-Q-wave myocardial infarction. There was one in-hospital noncardiac death. CONCLUSIONS In this consecutive series of patients with ISR of degenerated SVGS undergoing PCI without distal protection, there were no episodes of slow flow/no reflow and no procedure-related myocardial infarctions. It appears that distal embolic protection may not be necessary during PCI of ISR lesions in degenerated SVGS. (C) 2003 by the American College of Cardiology Foundation.