Carolyn M Webb1, Eyal Orion2, David P Taggart3, Keith M Channon4, Carlo Di Mario5. 1. Department of Cardiology, National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital, and the National Heart & Lung Institute, Imperial College London, London, UK c.webb@imperial.ac.uk. 2. Vascular Graft Solutions, Tel Aviv, Israel. 3. Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Oxford, UK. 4. Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK. 5. Department of Cardiology, National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital, and the National Heart & Lung Institute, Imperial College London, London, UK.
Abstract
AIMS: The Venous External Support Trial (VEST) evaluated whether a novel external stent attenuated saphenous vein graft (SVG) disease assessed with intravascular ultrasound 1 year following coronary artery bypass graft (CABG) surgery. This sub-study assessed SVGs with and without external stenting using optical coherence tomography (OCT). The aim of this study was to accurately compare quantitative and qualitative features of SVGs with and without a novel external stent using OCT. METHODS AND RESULTS:Twenty-four of 30 patients (65 ± 8 years) enrolled inVEST underwent coronary angiography with OCT imaging using a non-occlusive technique. Quantitative analysis of lumen area was performed in one frame every 10 mm along the length of the graft, from distal to proximal anastomosis, and pathological features within the lumen were noted. Mean cross-sectional area was greater in unstented vs. stented grafts (8.4 ± 3 vs. 7.6 ± 2.7 mm; P = 0.005). The lumen of the stented grafts was more homogeneous (difference between maximum and minimum lumen diameter was significantly smaller in stented compared with unstented grafts, 0.28 ± 0.19 vs. 0.33 ± 0.23 mm, respectively, P = 0.006), and more circular (mean eccentricity index 0.08 ± 0.06 vs. 0.10 ± 0.06, stented vs. unstented; P = 0.019). Adherent thrombus was identified in three grafts (all unstented). CONCLUSION: Our findings highlight the early changes occurring in SVGs after implantation of aorto-coronary bypass conduits, changes that may accelerate vein graft failure. External stenting resulted in a more homogeneous and less eccentric lumen with no thrombus formation. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: The Venous External Support Trial (VEST) evaluated whether a novel external stent attenuated saphenous vein graft (SVG) disease assessed with intravascular ultrasound 1 year following coronary artery bypass graft (CABG) surgery. This sub-study assessed SVGs with and without external stenting using optical coherence tomography (OCT). The aim of this study was to accurately compare quantitative and qualitative features of SVGs with and without a novel external stent using OCT. METHODS AND RESULTS: Twenty-four of 30 patients (65 ± 8 years) enrolled in VEST underwent coronary angiography with OCT imaging using a non-occlusive technique. Quantitative analysis of lumen area was performed in one frame every 10 mm along the length of the graft, from distal to proximal anastomosis, and pathological features within the lumen were noted. Mean cross-sectional area was greater in unstented vs. stented grafts (8.4 ± 3 vs. 7.6 ± 2.7 mm; P = 0.005). The lumen of the stented grafts was more homogeneous (difference between maximum and minimum lumen diameter was significantly smaller in stented compared with unstented grafts, 0.28 ± 0.19 vs. 0.33 ± 0.23 mm, respectively, P = 0.006), and more circular (mean eccentricity index 0.08 ± 0.06 vs. 0.10 ± 0.06, stented vs. unstented; P = 0.019). Adherent thrombus was identified in three grafts (all unstented). CONCLUSION: Our findings highlight the early changes occurring in SVGs after implantation of aorto-coronary bypass conduits, changes that may accelerate vein graft failure. External stenting resulted in a more homogeneous and less eccentric lumen with no thrombus formation. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Margreet R de Vries; Karin H Simons; J Wouter Jukema; Jerry Braun; Paul H A Quax Journal: Nat Rev Cardiol Date: 2016-05-19 Impact factor: 32.419
Authors: David P Taggart; Carolyn M Webb; Anthony Desouza; Rashmi Yadav; Keith M Channon; Fabio De Robertis; Carlo Di Mario Journal: J Cardiothorac Surg Date: 2018-11-19 Impact factor: 1.637
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