A novel approach to aortocoronary saphenous venous graft percutaneous treatment Priority PaPer evaluation

Evaluation of: Abizaid A, Weiner B, Bailey SR, Londero H: Use of a self-expanding super-elastic all-metal endoprosthesis; to treat degenerated SVG lesions: the SESAME first in man trial. Catheterization and cardiovascular interventions. J. Soc. Cardiac Angiogr. Interv. 76(6), 781–786 (2010). Saphenous veins remain an important conduit in coronary artery bypass surgery. However, owing to accelerated atherosclerosis, approximately 50% of grafts are occluded by 10 years making the percutaneous treatment the preferable approach. Previously, the results of percutaneous treatment of saphenous vein grafts (SVGs) were affected by the high rates of periprocedural myocardial infarction and restenosis/occlusion. These unfavorable results were supplanted, in part, by the use of embolic protection devices (EPDs). However, less than 25% of SVG lesions have the anatomical criteria for the use of EPDs. Moreover, their use adds complexity to the procedure and requires training. This first-in-man study describes a novel nanosynthesized, membranecovered self-expanding superelastic all-metal endoprosthesis stent (SESAME StentTM) in 20 patients undergoing percutaneous intervention of SVG (21 lesions with an average length of 8.9 mm) without EPDs. The acute success rate was 100%. No complications occurred and the incidence of major adverse cardiac events (MACE) at 30 days and 9 months was 0 and 14%, respectively. Larger trials with more complex SVG lesions are warranted to determine if the SESAME stent can improve the outcomes of SVG percutaneous treatment.