PCI To Saphenous Vein Graft

By Ting Yuen Beh, Rohith Stanislaus, Azlan Hussin


Ting Yuen Beh


Ting Yuen Beh1, Rohith Stanislaus1, Azlan Hussin1


National Heart Institute, Malaysia1,
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PCI To Saphenous Vein Graft

Ting Yuen Beh1, Rohith Stanislaus1, Azlan Hussin1

National Heart Institute, Malaysia1,

Clinical Information

Relevant Clinical History and Physical Exam

This is a 78 years old lady with history of coronary artery bypass surgery done in 2007. She had LIMA-LAD and sequential SVG to right posterior descending artery and obtuse marginal artery. She presented with acute angina while at rest with no signs of heart failure. Haemodynamics were stable with no pulmonary congestion. ECG showed ST depression V4-V6 and raised troponin T. She was diagnosed as non ST elevation myocardial infarction and admitted for stabilization. 

Relevant Test Results Prior to Catheterization

ECG showed sinus rhythm with ST depression over V4-V6
troponin T 47 pg/ml
Echocardiography showed LVEF 47% with areas of hypokinesia

left system.mpg

Relevant Catheterization Findings

Coronary AngiogramLMS: calcified; CTO from ostialRCA: calcified; severe diffuse disease from ostial
LIMA-LAD: patent graftSequential SVG to RPDA & OM: severe stenosis at anastomotic site 

Interventional Management

Procedural Step

Right femoral artery punctured with 6F sheath and diagnostic catheters (JR 3.5/6F and JL 4/6F)) were used during diagnostic shots. PCI to SVG was performed using guiding JR 3.5/6F and guide extension Guidezilla II . Runthrough wire crossed the lesion in SVG smoothly.  The lesion was predilated with scoring balloon 2.0/10mm (up to 12 atm) and the balloon opened up well. We decided to stent with drug eluting stent 2.75/18mm, deployed at nominal pressure. The stent was then post dilated with non compliant balloon 3.0/10mm, up to 12 atm pressure.Final shots showed good result with TIMI 3 flow and no stent edge dissection seen. 
cau (final).mpg

Case Summary

This case illustrates a case of post coronary artery bypass graft patient who presented with acute coronary syndrome. Coronary angiography showed severe disease in her native coronaries and severe stenosis at the saphenous vein graft to right posterior descending artery. The native coronaries are deemed difficult to revascularize as compared to the graft. Therefore, we proceeded with percutaneous coronary intervention to the saphenous vein graft using drug eluting stent without any complications. The patient recovered well and remained asymptomatic till today.