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Angioplasty versus stenting for cardiac allograft vasculopathy

Robert S Dieter, Greg M Gauthier, Aravinda Nanjundappa and Matthew R Wolff

Background: Nearly all cardiac allografts develop a unique vasculopathy. Cardiac allograft vasculopathy (CAV), coupled with atherosclerotic coronary artery disease remains the primary cause for late allograft dysfunction. There is limited data comparing angioplasty to stenting for CAV. Methods: A qualitative analysis was performed to determine if further investigation of differences between angioplasty and stenting is required for CAV. A retrospective examination of patients with a cardiac transplant who developed CAV requiring percutaneous coronary interventions was performed. Baseline data were obtained on the patients. Annual coronary angiograms were performed for the diagnosis of CAV and to determine the patency after a percutaneous coronary intervention (quantitative coronary angiography was not performed). The primary end point was restenosis of the target lesion. Angioplastied lesions were compared with stented lesions for restenosis rate and time to first restenosis. Results: From 1984 to 2000, there were 452 cardiac transplants at our institution. A total of 11 patients received angioplasty and nine patients received a coronary artery stent. Overall, there were fifteen lesions angioplastied (73% restenosed) and thirteen lesions stented (15% restenosed). The time to restenosis was earlier in the stent group- 4 months vs. 25.9 months. Conclusion: The results suggest that if a CAV lesion is to be intervened upon, stenting provides a more durable treatment than angioplasty. This qualitative analysis confirms the necessity to quantitatively determine the difference between angioplasty and stenting for CAV.