DIRECTIONAL CORONARY ATHERECTOMY OF SAPHENOUS-VEIN GRAFT NARROWINGS - MULTICENTER INVESTIGATIONAL EXPERIENCE

Directional coronary atherectomy (DCA) of saphenous vein graft lesions was performed at 21 centers between June 1988 and September 1990, which represents the multicenter investigational experience. A total of 318 procedures were performed and 363 vein graft lesions were treated. Angiographic success with DCA was achieved in 86% of lesions and clinical success was achieved in 85% (269 of 318) of patients. Major complications occurred in 2.5% of patients, with Q wave myocardial infarction (MI) in 1.3%, death in 0.9%, and urgent bypass surgery in 0.9% Other complications included non-Q wave MI in 4.4%, distal embolization in 7.2%, coronary occlusion in 1.9%, and vessel perforation in 0.6%. Although there was a trend toward lower success rates with ostial vein graft lesions (82% vs 88% for other graft sites) and with diffuse (length > 20 mm) graft lesions (75% vs 87% for shorter lesions), the differences were not significant. Baseline clinical and angiographic factors did not identify predictors of lower success or more frequent complications in the study group. Overall restenosis rate in the 149 patients with angiographic restudy was 57%. The restenosis rate was significantly lower with primary vein graft lesions (38%) compared with a 75% restenosis rate for grafts with prior restenosis, p < 0.001. This initial multicenter investigational experience indicates that directional coronary atherectomy is a safe and effective therapy for selected saphenous vein graft disease. Although the overall restenosis rate is relatively high, the restenosis rate following DCA of primary vein graft lesions is significantly lower than for vein grafts having had prior intervention. Comparative studies of DCA with balloon angioplasty or other technologies will be necessary to determine the optimal interventional therapy for saphenous vein graft disease.