CASE20230825_006
PCI To Saphenous Vein Graft
By Ting Yuen Beh, Rohith Stanislaus, Azlan Hussin
Presenter
Ting Yuen Beh
Authors
Ting Yuen Beh1, Rohith Stanislaus1, Azlan Hussin1
Affiliation
National Heart Institute, Malaysia1,
View Study Report
CASE20230825_006
DES/BRS/DCB - DES/BRS/DCB
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
RCA.mpg
troponin T 47 pg/ml
Echocardiography showed LVEF 47% with areas of hypokinesia
left system.mpg RCA.mpgRelevant 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
LIMA-LAD.mpg
SVG-RPDA.mpg
LIMA-LAD: patent graftSequential SVG to RPDA & OM: severe stenosis at anastomotic site
LIMA-LAD.mpg SVG-RPDA.mpgInterventional 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
cau (final).mpgCase 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.