目的:关于外支架减轻大隐静脉移植物长期疾病进展的潜力的数据很少。我们研究了外支架对隐静脉移植疾病进展的影响。
方法:共184例接受单纯冠状动脉旁路移植术的患者,使用胸廓内动脉移植物和至少2个额外的隐静脉移植物,在14个欧洲中心注册。一个隐静脉移植物被随机分配到一个外部支架,1个无支架的隐静脉移植物作为对照。主要终点是通过血管造影术评估的隐静脉移植物Fitzgibbon通畅量表,次要终点是在2年时通过血管内超声评估的隐静脉移植物内膜增生.
结果:在2年完成了128例患者的血管造影和整个预设队列(n=51)的血管内超声检查。支架和非支架隐静脉移植物的总体通畅率相似(78.3%vs82.2%,P=.43)。然而,Fitzgibbon通畅程度量表在有支架的和无支架的隐静脉移植物中显著改善,用Fitzgibbon通畅度量表I,II,III率分别为66.7%和54.9%,27.8%对34.3%,5.5%对10.8%,分别(赔率比,2.02;P=.03)。Fitzgibbon通畅度量表与隐静脉移植物最小管腔直径成反比,用Fitzgibbon通畅度量表I,II,和平均最小管腔直径为2.62mm的III大隐静脉移植物,1.98mm,和1.32毫米,分别为(P<0.05)。外支架大隐静脉移植物也显示平均内膜增生面积(22.5%;P<.001)和厚度(23.5%;P<.001)显著减少。
结论:冠状动脉旁路移植术后两年,外支架可改善大隐静脉移植物的Fitzgibbon通畅性,并显着减少内膜增生面积和厚度。这是否最终会导致改善长期通畅性仍然是未知的。
OBJECTIVE: Little data exist regarding the potential of external stents to mitigate long-term disease progression in saphenous vein grafts. We investigated the effect of external stents on the progression of saphenous vein graft disease.
METHODS: A total of 184 patients undergoing isolated coronary artery bypass grafting, using an internal thoracic artery graft and at least 2 additional saphenous vein grafts, were enrolled in 14 European centers. One saphenous vein graft was randomized to an external stent, and 1 nonstented saphenous vein graft served as the control. The primary end point was the saphenous vein graft Fitzgibbon patency scale assessed by angiography, and the secondary end point was saphenous vein graft intimal hyperplasia assessed by intravascular ultrasound in a prespecified subgroup at 2 years.
RESULTS: Angiography was completed in 128 patients and intravascular ultrasound in the entire prespecified cohort (n = 51) at 2 years. Overall patency rates were similar between stented and nonstented saphenous vein grafts (78.3% vs 82.2%, P = .43). However, the Fitzgibbon patency scale was significantly improved in stented versus nonstented saphenous vein grafts, with Fitzgibbon patency scale I, II, and III rates of 66.7% versus 54.9%, 27.8% versus 34.3%, and 5.5% versus 10.8%, respectively (odds ratio, 2.02; P = .03). Fitzgibbon patency scale was inversely related to saphenous vein graft minimal lumen diameter, with Fitzgibbon patency scale I, II, and III saphenous vein grafts having an average minimal lumen diameter of 2.62 mm, 1.98 mm, and 1.32 mm, respectively (P < .05). Externally stented saphenous vein grafts also showed significant reductions in mean intimal hyperplasia area (22.5%; P < .001) and thickness (23.5%; P < .001).
CONCLUSIONS: Two years after coronary artery bypass grafting, external stenting improves Fitzgibbon patency scales of saphenous vein grafts and significantly reduces intimal hyperplasia area and thickness. Whether this will eventually lead to improved long-term patency is still unknown.