Efficacy and Safety of Direct Stenting Versus Stenting with Distal Protection Devices in Percutaneous Intervention of Saphenous Vein Grafts: A Comparative Study.
DOI:
https://doi.org/10.55958/jcvd.v20i4.229Abstract
Background-: Saphenous vein grafts (SVGs) used in coronary artery bypass grafting (CABG) often develop significant atherosclerosis, leading to the need for Coronary Angioplasty. This study compares Direct Stenting (DS) and Stenting with a Distal Protection Device (DPD) in subjects with SVG lesions to assess their impact on clinical outcomes and procedural success.
Purpose-: To compare and contrast Direct Stenting and Stenting with Distal Protection Devices in the context of SVG interventions
Methods-: This single-blind, prospective experimental study included 64 patients with saphenous vein graft (SVG) lesions undergoing PCI at Punjab institute of cardiology Hospital Lahore from August 2023 to August 2024. Participants were randomly assigned by balloting method into two groups: Group I (32 patients) received stenting with a distal protection device (DPD), while Group II (32 patients) underwent direct stenting without a DPD. Patients were selected based on specific inclusion criteria and were excluded if they had severe renal impairment, decompensated heart failure, or other contraindications. The study assessed procedural outcomes, including clinical success, myocardial infarction, and revascularization needs, with a 30-day follow-up to monitor cardiac events and complications.
Results-: The study included sixty-four patients with an average age of 61.25 years, plus or minus 9.44 years with a gender distribution of 95.3% male and 4.7% female. The prevalence of diabetes, hypertension, and smoking was 51.6%, 56.3%, and 54.7%, respectively. The lesion locations were categorized as ostial (12.5%), proximal (57.8%), mid (25%), and distal (4.68%). No substantial differences were observed between the DPD and DS groups regarding age, gender distribution, or initial clinical characteristics.
Notable differences were noted between the Distal Protection Device and Direct Stenting groups in terms of thrombus burden, stent diameter, and CPK levels both before and after the procedure. However, no significant differences were found in inflation pressure, number of stents, or TIMI flow grade between the two groups.
The study revealed that in-hospital and 30-day follow-up outcomes demonstrated clinical success rates of 100% for both the Distal Protection Device and Direct Stenting groups. There were no cases of abrupt closure or Q-wave MI. Mortality rates were 3.1%, and non-Q-wave MI rates were 0% for the DPD group and 3.1% for the DS group, indicating similar outcomes between the two groups.
Conclusions-: Both Direct Stenting and Stenting with a Distal Protection Device showed remarkable success Rate and minor adverse event rates in SVG lesions. However, DPD use may reduce distal embolization, warranting further studies for confirmation and long-term outcomes.
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