JACC Febntary 1996 ABSTRACTS - Oral 179A 4:15 ~ Major Isehemic Events After Successful Treatment of Sephenous Vein Graft Lesions-- Importance of Anglographicelly "Non-Signiflcent" LeMons Stephen G. Ellis, Sorin Brsner, Patrick L. Whitlow. The ClevelandClinic Foundation, Cleveland, OH Patients (pts) with pemutaneousintervention (PTCR) of saphenousvein graft (SVG) lesions have a high rate of recurrent ischemic events (RIE) (death, MI, CABG, PTCR). To Investigatethe etiology and timing of these adverse outcomes, all pts with suecassfalSVG PTCR in a study with required follow- up cath during 1990-93 were studied (n = 102). The initial PTCR in these pts was stent = 59 sites, angiaplasty= 59, TEC = 45, other = 16. SVG were each prospectively divided into 7 segments (seg) (total evaluated = 1067). SVG and native (NAT) vessels were separated into those with and without initial treatment (rx). % of Recurrent Ischemic Events DudngInterval Tim EveN-free Survival SVG-rx SVG-no rx NAT-RX NAT-no rx 6 moe 67,0% 55 27 4 14 12 mos 49.0% 57 24 5 14 18 mos 40.4% 25 50 0 25 36 mos 25.8% 33 44 0 22 overall -- 50 30 4 16 RIE in initially rx'd SVG-segwere correlated with initial % caliper stenosis (initial > 75=/0: 43% RIE, 50-75%: 27%, < 50%: 18%, p = 0.01), but not final % stenosis. RIE in initially non-rx'd SVG-seg were correlatedwith reference SVG diameter (p = 0.002) and especially with initial % stenosis(initial <_ 30"/0: 1.8%RIE, 31-40%: 28.6%, 41--50%: 37.8%; p < 0.001). Conclusions: 1) RIE after SVG PTCR are common; 2) events from the initially treated site(s) predominate for the first 6-12 mos, while events from non-treated SVG sites predominate later; 3) the high rate of RIE from non- treated ~- 38-50% stenoses suggests a need for increased surveillance in pts with these lesions;and 4) the low rate of RIE from treated < 5(P/o stenoses suggests that the hypothesis that these "non-significant" lesions might best be treated initially should be examined. 4:30 ~76~] Favorable Results of Followed Debulking by Immediate Adjunct Stent Therapy for High Risk Saphenous Vein Graft Lesions Mun K. Hong, S. Chiu Wang, Jeffrey J. Popma, Lowell F. Satier, Kenneth M. Kent, Augusto D, P/chard, Gary S. Minfz, Theresa Bucher,Alan J. Merdtt, J. Hope Pacera,Martin B. Leon. Washington Hospital Center, Washington, DC Stants are the preferredtherapy for saphenous vein graft lesions (SVG), but appropriate timing (immediatevs. staged) and optimal adjuncttherapy before stenting in high nsk (totally occluded, thrombus-containieg, or di=genecated) SVG are unknown. To determine the safo~, and efficacy of a sbatagy com- prising initial thmmbus/tissue debulking followed by immediate stenting, we reviewed our expenences with transluminal extraction atherectomy (TEC, n = 36) and excimer laser angioplasty (ELCA using 3aliceflush technique and 2 mm catheters, n = 81) before stanting in high nsk SVG. Baseline charac- tedsflcs were similar for TEC + Stent vs ELCA + Stent and for the overall high dsk SVG group (n = 117) included 92% unstableangina, mean graft age of 8.7 yrs, 21% thrombus, 9% total occlusions, and 20°/,, SVG degeneration, Procedure success was defined as final diameter stsnosis < 50"/,, without major complications (death, Q-wave MI, or emergencyCABG). Non-Q wave MI was defined as CPK-MB > 5 x normal. TEC + slant ELCA + slent Procedural success (%) 100 100 Majorischemic complications (O/o) 0 0 Non-Q Wave MI (%) 15.6 8.7 In-lab closure(%) 2.9 0 No-reflow (%) 2.2 0 We conclude: Dabulking with TEC or ELCA followedby immediate stent- ing results in excellentprocedure success and rare ischemioor angiographic complications. Thus, TEC or ELCA + stents may be the prefen'ed interven- tional therapy for high dsk SVG lesions. 4:45 ~ Anatomy Reconstruction of Native Coronary Armnes and Veto Grafts With the Less Shortening Serf-Expandable Wallstent Jean Marco,Jean Fajadet, Philippe BnJcel, Christian Jordan, Bernard Cass~gneau,Jean-Piewe Laurent. Clinique Pasteur, Toulouse, France The modifications in braiding angle of the self-expanding Wallstent has re- suited in less shortening upon expansion and a reduction in radial force. The customized range of diameters (3.5--6.0ram) and lengths (18-49 ram) after the deployment of an oversized Walls'tentallow to treat very long and complex lesions in native coronary artefias or grafts. Between December 1994 and July 1995, 60 patients(10ts ) with complex long (lesion length: 29.8:1:14.9 mm) were treated with implantation of 1 (3910ts) or more (21 10is) Walistants selectedwilh an unconstrained nominal diameterof 1.5 mm greater than maximaldiametervessel (MDV). Post stent delivery, high pressure (> 15 arm) intra stent inflation was systamaticaly performed, The vessel disthl~lion was RCA: 20, LAD :15, LCX :9, SVG :21 The averagenominaldiameter and length of deployed Wallstent was 4.6 4- 0.64 mm and 33.3 a- 9.2 ram. The pre-MVD was 3.48 ± 0.42 mm and the post stant minimun lumen diameter was 3.4 4- 0.51 ram. Post procedure therapy consistedof aspidn and ticlupidine. One patient(1.7%) stopped ticlopidineon day 10 and sustained subacute closure on day 17 successfully treated with streptokinase.No other subecutethmmbeses,deaths, myocardial infarctions or repeatinfervenfions occurred between 1 to 7 months of clinical follow-up. Conclusion:The use of oversizedand longWallstentallows a reconstrution of lumen and a resetting of the vessel size. Initial clinical results with ticlopidin + aspidn appear promising. Long term angiographic follow-up remains to be determined. 5:00 VT"~'~ Compaseionate Endoluminal Grafting for Peroutsneous Treatment of Aortocoronary SVG Disease R.R. Heuser,G.T. Reynolds, C. Papazoglou,E.B. Diethrich, R. Mukherjee. Arizona Heart Institute, Phoenix, AZ Endoluminalgrafts (ELG)composedof an expandablePTFE ~,,be graft/Palmaz slant device were implanted percutaneousty with a low-profile ~.ystem to treat saphenous vein graft (SVG) disease in 6 patients with no Other :~urgical or percutaneoustreatment options. Mean patientage was 64 y (range 47-77). Three patients had aneurysms, 2 had multiple restenoses, and 1 had diffuse disease. Two cases were unsuccessful as a msuft of prolonged hypotaasion dudng attempted graft insenfon in one case, which responded to fluid and blood adminislratien, and the inability to predilate the lesion in the second case. Procedural success was achieved in four patients (67%). In these cases, ELGs were deployed in the SVG to the right coronary artery in one patientand in the SVG to the obtuse marginalbranch in three patients. Mean graft age was 122 months (range 19-240). Mean lesion length was 38 mm (range 25-49) and graft length was 68 mm {range 52-92). At mean 260<1 follow-up (range 186-392), angiography confirmed widely patent grafts in two patients and three instances of subasute thrombosis in the remaining two patients. At last follow-up, all 4 patients remained free of angina. These early resultsindicatethat ELGs may be an effectivetrealment for aneurysmal and severely diseased SvGs in pa~entswith poor percutanaous or surgical options. The size of the diseased SVG may play a role in the success of the procedure: in this sades, subacutethrombosishas been seen only in smaller grafts (< 3 ram); grafts > 4 mm had no aegiographic, angioscopic, or ultra- sound evidence of intimal growth. Furtherstudy is warranted to determine if the nonporous PTFE graft is resistantto intimal growth in follow-up. 5:15 Autologous Vein Graft-Coated Stent for the Treatment of Coronary Artery Disease: Immediate Results After Peroutaneous Implantation in Humans Chdsledoulos Stofanadis, ElefthedusTslamis, KonstantinosToutouzas, CharalambosVlachopouloe,ioannis KalSkazeros, Costas Stmtos, Manolis Vevuranalds,Asimakis Sidefis, Pavio~, Toutouzas. Athens University, Greece Background: Acute closure and late restenosis remain the major limitations of stenting. We have earlier reportedthe successful experimental application of the autalog0us vein graft-coated stent (AVGCS),that consists of a con- ventional stent covered by a vein graft. We now report the immediate results of the implantation of the AVGCS in 13 patients (pts) with coronary artery disease. Methods: The right cephalic vein was isolated and approximately