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To the Editor: In the PREVENT IV study,¹ edifoligide did not affect the rate of VGF, and on the basis of angiographic data the PREVENT IV investigators concluded that edifoligide did not have an appreciable effect on neointimal hyperplasia. We believe it may be premature to conclude that the lack of clinical benefit is due to a failure to inhibit neointimal proliferation and suggest 3 alternative explanations.

First, remodeling of vein grafts in the early postoperative period is substantial^2-3 and may confound the determination of intimal thickness by luminal angiography. Minor differences in the degree of remodeling of vein grafts could obscure effects on neointimal thickening.

Second, if neointimal proliferation was inhibited, as might be expected from preclinical studies of edifoligide,⁴ neointimal proliferation may be more relevant to later causes of VGF (such as providing a substrate for later atherodegenerative change in the vein graft) than to failure in the . . . [Full Text of this Article]

George T. Lau, MBBS
george.lau@email.cs.nsw.gov.au

Leonard Kritharides, MBBS, PhD
Concord Hospital
Sydney, Australia

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