INVESTIGATIONAL USE OF THE PALMAZ-SCHATZ BILIARY STENT IN LARGE SAPHENOUS-VEIN GRAFTS

Percutaneous therapy of saphenous vein graft stenoses accounts for 8% of interventional procedures in our catheterization laboratory. Conventional balloon angioplasty is frequently unsatisfactory owing to poor acute results and a high restenosis rate, particularly in grafts >3 years of age.1 In contrast, percutaneous Palmaz-Schatz stent placement or directional coronary atherectomy each seem to provide better acute results with somewhat lower restenosis rates.2,3 The conventional Palmaz-Schatz coronary stent, however, distorts when expanded ≥5.0 mm in diameter. Whereas directional coronary atherectomy is approved for general use, currently available 7Fr graft devices fail to produce a lumen diameter >4.0 mm without adjunctive conventional angioplasty after atherectomy. Because recent studies have shown that the possibility of restenosis is inversely related to the postprocedure lumen diameter,4 it should be possible to achieve very low restenosis rates in large (≥4.5 mm diameter) saphenous vein graft stenoses by more complete dilatation. To this end, we report the investigational use of the balloon-expandable Palmaz-Schatz biliary stent (expanded diameter 4 to 7 mm) in 6 patients who developed focal stenosis in such grafts after bypass surgery. © 1993.