Saphenous vein graft disease treated with the Wiktor Hepamed stent: procedural outcome, in-hospital complications and six-month angiographic follow-up

OBJECTIVES

To evaluate the effectiveness of electively placed heparin-coated stents in the treatment of coronary saphenous vein bypass grafts with de novo lesions less than 15 mm in diameter in a prospective study with all eligible consecutive patients presenting to Middelheim Hospital, Antwerp, Belgium between September 1997 and August 1998.

PATIENTS AND METHODS

Fifty patients with 53 lesions were studied. Anginal class, risk factors, quantitative coronary angiographic measurements pre- and postprocedure, procedural outcome, in-hospital events, clinical status on discharge, and six-month clinical and angiographic follow-up (in 48 patients) were recorded. All patients received acetylsalicylic acid and ticlopidine, unless known intolerance was present.

RESULTS

On average, 1.1 stents/patient were placed in very old saphenous vein grafts (11. 7+/-3.9 years). Procedural success was 98%. Only two non-Q wave myocardial infarctions (MIs) occurred, with no Q-wave MIs and no deaths during hospital stay. Length of hospital stay was short (2. 4+/-1.7 days), and 96% of patients were free of angina on discharge. At six-months' follow-up, two patients had died, one of whom died of a noncardiac cause. One patient suffered a non-Q wave MI. At six months, 86% of patients were free from angina. Minimal luminal diameter decreased from 1.14 mm before to 3.33 mm after stenting and to 2.52 mm at six months. Restenosis was present in 22% of patients (21.6% of lesions).

CONCLUSIONS

In a selected population with coronary saphenous vein bypass graft disease, Wiktor heparin-coated stents can be delivered with an excellent periprocedural outcome. Six-month outcome appears favourable with a low recurrence of angina (18%) and a low rate of angiographic restenosis (21.6%).

Intralobar pulmonary sequestration supplied by the right coronary artery

Bronchopulmonary sequestrations are malformations that are often congenital; they consist of isolated nonfunctioning lung segments having no communication with functional tracheobronchial elements of the surrounding lung. They are supplied by single or multiple branches from the distal thoracic or proximal abdominal aorta, or from the celiac, splenic, intercostal, subclavian, or pulmonary artery. Due to the absence of ventilation, the lung tissue can become chronically infected. We describe an intralobar pulmonary sequestration with arterial supply from the right coronary artery.

Elective Wiktor GX stenting for symptomatic stenosis in old aortocoronary saphenous vein bypass grafts: the Antwerp experience

PURPOSE

We compared initial outcome, peri-procedural complications and long-term clinical follow-up of elective Wiktor GX stent implantation in severely narrowed vein grafts to a historic register of elective angioplasties in saphenous vein grafts in the same center.

METHODS

Eighty-one consecutive patients with angina and a history of coronary artery bypass grafting (CABG), all received elective angioplasty (PTCA) of the diseased graft; we described them as group P. The next 38 consecutive patients were treated with elective angioplasty and Wiktor Stent implantation, followed by one month ticlopidine; they were called group S.

CONCLUSION

This retrospective study suggests that elective Wiktor stenting in old saphenous vein graft stenosis, in combination with one month ticlopidine, leads to: 1) a better angiographic result, with reduction of peri-procedural complications; and 2) a lower incidence of recurrent angina, need for invasive or surgical re-intervention, myocardial infarction and death during follow-up.

Aortic coarctation: a rare and unexpected cause of secondary arterial hypertension in the elderly

We present a 72-year-old man with long-standing moderate hypertension, due to an aortic coarctation, who presented with a myocardial infarction. In view of his advanced age the aortic coarctation was treated conservatively.

Transcatheter embolization of a bronchial side branch of the internal mammary artery for the treatment of a coronary steal phenomenon

We present a 58-yr-old woman with unstable angina due to a coronary steal phenomenon down a bronchial side branch draining into the pulmonary circulation, 1 yr after coronary bypass grafting. The patient was cured of angina pectoris after microcoil embolization of the bronchial side branch.

Stenosis in a coronary collateral artery--a case report

The coronary cineangiography of a man with an inferoposterior myocardial infarction is reported. An occlusion of the proximal right coronary artery and an occlusion at the origin passing around the left atrial wall of the circumflex artery was observed. A large collateral artery connected the right coronary artery and the distal circumflex artery. This vessel showed a significant stenosis of 70%. This case suggests that collateral arteries are not protected from atherosclerotic degeneration. Alternatively, since the exact caliber of the anastomosis before the occlusion of the recipient artery is not known, an extrinsic compression or kinking may have generated the stenosis at the time of the flow-related dilatation of the vessel.