Comparison of the slow-release polymerbased paclitaxel-eluting Taxus-Express stent with the bare-metal Express stent for saphenous vein graft interventions
The paclitaxel-eluting Taxus-Express stent is superior regarding angiographic and clinical outcome compared with its bare-metal platform for lesions in native coronary arteries. We studied the potential impact of the Taxus-Express stent in comparison with its bare-metal counterpart for treatment of lesions in saphenous vein grafts (SVGs). Furthermore, a metaanalysis was performed regarding use of drug-eluting (DES) vs bare-metal stents (BMS) in SVG lesions.
We analyzed 13 consecutive patients who underwent percutaneous revascularization in SVG lesions using the slowrelease, paclitaxel-eluting Taxus- Express stent. These lesions were balanced with 26 patients with SVG lesions treated with the baremetal Express stent (BMS) in the preceding period. Angiographic follow-up was performed after 6 months, clinical follow-up after 6 and 12 months.
There were no statistically significant differences regarding clinical, procedural and angiographic parameters pre and post intervention. Binary restenoses occurred significantly less in the Taxus group compared with the BMS group (0% vs 34.6%; p=0.016). This translated into a significantly lower occurrence of major adverse cardiac events (death, Q-wave myocardial infarction, repeat target vessel revascularization) in the Taxus group compared with the BMS group at the 6-month (0% vs 26.9%, p=0.039) and 12-month follow-up (7.7% vs 38.5%, p=0.045). Multivariate predictors for freedom of binary restenosis were the reference diameter pre intervention and treatment with Taxus stents. Metaanalysis including 280 DES and 256 BMS patients revealed an odds ratio of 0.34 (95% confidence interval 0.21–0.54) for MACE and 0.26 (95% confidence interval 0.16–0.44) for target vessel revascularizations, both favoring DES.
We conclude that the use of the slow-release Taxus-Express stent has the potential to be superior regarding angiographic and clinical outcome compared with its bare-metal counterpart for treatment of SVG lesions within a 12-month follow-up. A large, randomized trial including a long follow-up period is now required to prove the results of the metaanalysis.
Key wordsSaphenous vein graft drug-eluting stent restenosis paclitaxel quantitative coronary analysis
Unable to display preview. Download preview PDF.
- 1.Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME, for the TAXUS-IV Investigators (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231PubMedCrossRefGoogle Scholar
- 2.Stone GW, Ellis SG, Cannon L, Mann JT, Greenberg JD, Spriggs D, O'Shaughnessy CD, DeMaio S, Hall P, Popma JJ, Koglin J, Russell ME; TAXUS V Investigators (2005) Comparison of a polymer-based paclitaxel- eluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial. JAMA 294:1215–1223PubMedCrossRefGoogle Scholar
- 3.Kastrati A, Mehilli J, von Beckerath N, Dibra A, Hausleiter J, Pache J, Schühlen H, Schmitt C, Dirschinger J, Schömig A, for the ISAR-DESIRE Study Investigators (2005) Sirolimuseluting stent or paclitaxel-eluting stent vs balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis: a randomized controlled trial. JAMA 293:165–171PubMedCrossRefGoogle Scholar
- 4.Stone GW, Ellis SG, O'Shaughnessy CD, Martin SL, Satler L, McGarry T, Turco MA, Kereiakes DJ, Kelley L, Popma JJ, Russell ME for the TAXUS V ISR Investigators (2006) Paclitaxeleluting stents vs vascular brachytherapy for in-stent restenosis within bare-metal stents. JAMA 295:1253–1263PubMedCrossRefGoogle Scholar
- 5.Wöhrle J, Nusser T, Kochs M, Reske S, Hombach V, Krause B (2006) Paclitaxel- eluting stent implantation (Taxus) compared with optimized intracoronary β-irradiation using a rhenium- 188 filled balloon catheter for treatment of in-stent restenoses. J Am Coll Cardiol 47(Suppl B):4BCrossRefGoogle Scholar
- 6.Savage MP, Douglas JS Jr, Fischman DL, Pepine CJ, King SB 3rd, Werner JA, Bailey SR, Overlie PA, Fenton SH, Brinker JA, Leon MB, Goldberg S (1997) Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. Saphenous Vein De Novo Trial Investigators. N Engl J Med 337:740–747PubMedCrossRefGoogle Scholar
- 7.Hanekamp CE, Koolen JJ, Den Heijer P, Schalij MJ, Piek JJ, Bar FW, De Scheerder I, Bonnier HJ, Pijls NH; Venestent Study Group (2003) Randomized study to compare balloon angioplasty and elective stent implantation in venous bypass grafts: the Venestent study. Catheter Cardiovasc Interv 60:452–457PubMedCrossRefGoogle Scholar
- 10.Chu WW, Rha SW, Kuchulakanti PK, Cheneau E, Torguson R, Pinnow E, Alexieva-Fournadjiev J, Pichard AD, Satler LF, Kent KM, Lindsay J, Waksman R (2006) Efficacy of sirolimuseluting stents compared with bare metal stents for saphenous vein graft intervention. Am J Cardiol 97:34–37PubMedCrossRefGoogle Scholar
- 13.Mishra S, Wolfram RM, Torguson R, Chu WW, Xue Z, Gevorkian N, Donekal S, Chan R, Pichard AD, Satler LF, Kent KM, Waksman R (2006) Comparison of effectiveness and safety of drug-eluting stents versus vascular brachytherapy for saphenous vein graft in-stent restenosis. Am J Cardiol 97:1303–1307PubMedCrossRefGoogle Scholar
- 16.Werner GS, Fritzenwanger M, Ferrari M, Figulla HR (2006) Successful prevention of lesion recurrence in chronic total occlusions treated with a paclitaxel-eluting polymer-based stent: 2-year results and long-term secondary patency. J Am Coll Cardiol 47(Suppl B):55bGoogle Scholar
- 17.Hoye A, Lemos PA, Arampatzis CA, Saia F, Tanabe K, Degertekin M, Hofma S, McFadden E, Sianos G, Smits PC, van der Giessen WJ, de Feyter P, van Domburg RT, Serruys PW (2004) Effectiveness of the sirolimus-eluting stent in the treatment of saphenous vein graft disease. J Invas Cardiol 16:230–233Google Scholar