Saphenous vein graft percutaneous coronary intervention

In this issue of the Netherlands Heart Journal, IJsselmuiden et al. present a multicentre randomised control trial in which the STENTYS self-expanding bare metal stent (BMS) is compared with the STENTYS paclitaxel-eluting stent (PES) in saphenous vein grafts (SVGs). Primary endpoint of the trial was late lumen loss at six months follow-up, secondary endpoint was major adverse cardiac events (MACE) at 12 months. In a total of 57 patients (BMS 27 patients vs. PES 30 patients), the authors demonstrate that late lumen loss at 6 months was not significantly different (0.53mm vs. 0.47mm; p= 0.86) and MACE was comparable (BMS 22.2% vs. PES 26.7%). The study is small and was hampered by slow enrolment, but with 57 patients and angiographic follow-up, the comparable late luminal loss is an acceptable and important result. The authors are to be commended for conducting and completing the study. The self-deploying STENTYS stent has several theoretical advantages for application in saphenous vein grafts, such as avoiding the risk of underor oversizing because the self-deploying struts of the STENTYS stent will comply with the size of the graft. In addition, struts may be better apposed once the thrombus is dissolved and the risk of distal embolisation may be reduced because the stent deploys from distal to proximal. Distal embolisation was reported not to be present and the use of distal protection devices was at the discretion of the operators. It is unfortunate that the investigators were not able to perform intravascular imaging to confirm sizing and correct apposition of the stent struts after placement and at angiographic follow-up. Routine troponin measurements following the percutaneous coronary intervention (PCI) procedure were not reported. The main limitation of the study is its small