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Outcome of Treatment of Aorto-Ostial Lesions
Involving the Right Coronary Artery or a Saphenous
Vein Graft With a Polytetrafluoroethylene-
Covered Stent
Konstantinos Toutouzas,
MD
, Goran Stankovic,
MD
, Takuro Takagi,
MD
,
Vassilis Spanos,
MD
, Carlo DiMario,
MD
,
PhD
, Remo Albiero,
MD
, Nicola Corvaja,
MD
,
Antonio Gaglione,
MD
, and Antonio Colombo,
MD
P
ercutaneous treatment of native coronary and sa-
phenous vein graft aorto-ostial (A-O) stenosis has
been associated with lower procedural success rates of
70% to 97%, more frequent in-hospital complications
of 5% to 12%, and a greater likelihood of late reste-
nosis of 28% to 52% when compared with the treat-
ment of nonostial lesions.
1–7
Stents, despite their
proved benefit in other indications, do not substan-
tially reduce the incidence of restenosis in A-O le-
sions.
5,6,8
Balloon expandable stents covered by a
polytetrafluoroethylene (PTFE) membrane have been
used for the treatment of de novo lesions in saphenous
vein grafts with favorable results.
9–11
The membrane
coverage yields a rationale to use the device in A-O
lesions, to prevent proliferation through the stent
struts from the aortic wall, and possibly decrease the
restenosis rate. We report the angiographic and imme-
diate and late long-term clinical results of the first
published cohort of patients that received PTFE-cov-
ered stents for the treatment of A-O lesions.
•••
The patient population consisted of 30 patients
who received a PTFE-covered stent (Coronary Stent
Graft, JOMED GmbH, Raigendingen, Germany) in
our center. All patients gave written consent. Baseline
clinical characteristics are listed in Table 1. Lesions
were localized at the aortic ostium of saphenous vein
grafts (n ϭ 18) or right coronary arteries (n ϭ 12).
Baseline total occlusion was present in 3 target lesions
(10%). Angiographically visible thrombus was ob-
served in 2 lesions (7%) and severe calcification in 2
lesions (7%).
Procedural details for PTFE-covered stent implan-
tation have been previously published.
9–11
Intravas
-
cular ultrasound (IVUS) was used at operator’s dis-
cretion. All patients received 250 mg of ticlopidine
twice daily, starting Ն48 hours before the procedure
and Ն100 mg of aspirin. Combined antiplatelet ther-
apy was prescribed for Ն3 months, and aspirin was
continued indefinitely in all patients. Revasculariza-
tion was performed on the basis of evidence of isch-
emia. The primary end point was the incidence of
6-month angiographic restenosis rate (diameter steno-
sis Ն50% at the angiographic follow-up). In addition,
the incidences of acute, subacute, and late thrombosis
were analyzed. An acute ischemic event leading to a
myocardial infarction in the segment supplied by the
target vessel was considered acute stent thrombosis if
it occurred within 24 hours from stent implantation,
subacute thrombosis if it occurred from 24 hours to 1
month, and late thrombosis if it occurred after 1
month, unless angiography demonstrated patency of
From the Centro Cuore Columbus and San Raffaele Hospital, Milan;
and Casa di Cura Villa Bianca, Bari, Italy. Dr. Colombo’s address is:
EMO Centro Cuore Columbus, Via M. Buonarroti 48, 20145 Milan,
Italy. E-mail: columbus@micronet.it. Manuscript received December
12, 2001; revised manuscript received and accepted February 28,
2002.
TABLE 1 Demographic Characteristics
Characteristic n ϭ 30
Age (yrs) 64 Ϯ 8
Men 27 (90)
Previous acute myocardial infarction 13 (43)
Previous balloon angioplasty 9 (30)
Previous bypass surgery 18 (60)
Systemic hypertension 21 (70)
Hypercholesterolemia (total cholesterol Ͼ230 mg/dl) 20 (67)
Smoker 13 (43)
Diabetes mellitus 5 (17)
Family history of coronary artery disease 12 (40)
Unstable angina pectoris 13 (43)
Multivessel coronary artery disease 19 (63)
Ejection fraction (%) 54Ϯ15
De novo 24 (80)
In-stent restenosis 6 (20)
Values represent numbers and percentages of the patients or mean Ϯ SD.
63
©2002 by Excerpta Medica, Inc. All rights reserved. 0002-9149/02/$–see front matter
The American Journal of Cardiology Vol. 90 July 1, 2002 PII S0002-9149(02)02390-1