Treatment of totally occluded saphenous vein grafts using self-expanding stents.

Patients with saphenous vein graft (SVG) disease represent an increasing proportion of those referred for percutaneous coronary intervention. The success of treatment of occluded SVG with percutaneous intervention has been limited by frequent occurrence of no-reflow phenomenon. Use of self-expanding stents with low pressure pre- and post-dilation may improve success by limiting embolism of atherothrombotic debris. The self-expanding stents provide a meshed design that helps to trap the atherothrombotic debris between the vessel wall and stent struts. Results with two patients are described to illustrate the proposed technique that appears to limit no-reflow during and immediately after the procedure. Adjunctive treatment with a GP IIb-IIIa inhibitor is likely to be of benefit as well. Additional studies are required to demonstrate definitively the potential benefits of this approach.