Mesh-Covered Stent Versus DES Implantation in Diseased Saphenous Vein Graft: Comparative Analysis of Short-Term Complications

Background: PCI for diseased Saphenous Vein Grafts (SVG) is considered a high risk procedure, with substantial rates of atheromatous and thrombotic embolization leading to coronary flow disturbances, Periprocedural MI and death. Since treatment possibilities have limited benefits once microvascular obstructions have occurred, the prevention of them remains of the utmost importance. A potential preventive strategy is the utilization of mesh-covered stents, such as the MGuard^TM stent (InspireMD –Tel Aviv, Israel). In this study we sought to explore the angiographic and clinical short term complications when performing SVG-PCI using MGuard^TM versus Drug eluting stents (DES).

Methods: We reviewed data from 86 cases of SVG-PCI with implantation of MGuard^TM, and 88 cases with implantation of DES over a 12-year period. The two groups were analyzed and compared in terms of baseline characteristics, angiographic complications, and 30-day clinical complications.

Results: We found no difference between groups regarding our primary endpoint, which was the composite of intraprocedural thrombotic events (No reflow /distal embolization), PMI and 30-day mortality (9.3% MGuard^TM vs. 8% DES, P=0.38). All individual rates of events were similar between groups as well. Independent predictors of the primary endpoint were also investigated, and found to be Total Stents Length (OR, 1.035; 95% CI 1.001-1.071, P= 0.047), and Stent Maximum Pressure (OR, 0.735; 95% CI 0.566-0.955, P= 0.021).

Conclusions: The mesh-covered stent (MGuard^TM) failed to prove any favorable angiographic or clinical outcomes compared with DES, when are applied for the angioplasty treatment of diseased SVG.