Proximal protection in recanalization of totally occluded saphenous vein grafts in acute coronary syndrome

Catheter Cardiovasc Interv. 2010 Jun 1;75(7):1051-5. doi: 10.1002/ccd.22413.

Abstract

Percutaneous treatment of old, degenerated saphenous vein grafts (SVG) is associated with a high likelihood of major adverse cardiac events. When an acute coronary syndrome (ACS) develops in a patient with old SVG, fresh thrombus may superimpose on an old, degenerative atheroma: a sudden increase in the athero-thrombotic burden ensues with consequent, frequent total occlusion of the lumen. In this scenario, transluminal recanalization of the graft is usually associated with the highest chance of distal embolization and no-reflow and positioning of an embolic protection device (EPD) is almost mandatory. However, distal EPD are difficult to place when the vessel is totally occluded and do not completely avoid distal embolization. We report two cases of totally occluded SVG in patients admitted for ACS that were recanalized with the aid of a proximal EPD system with angiographic and clinical success.

Publication types

  • Case Reports

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Coronary Syndrome / etiology
  • Acute Coronary Syndrome / physiopathology
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Angioplasty, Balloon, Coronary* / adverse effects
  • Angioplasty, Balloon, Coronary* / instrumentation
  • Cardiovascular Agents / administration & dosage
  • Coronary Angiography
  • Coronary Artery Bypass / adverse effects*
  • Drug-Eluting Stents
  • Embolism / etiology
  • Embolism / prevention & control
  • Equipment Design
  • Everolimus
  • Female
  • Filtration / instrumentation
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Male
  • Metals
  • Middle Aged
  • Prosthesis Design
  • Saphenous Vein / diagnostic imaging
  • Saphenous Vein / physiopathology
  • Saphenous Vein / transplantation*
  • Sirolimus / administration & dosage
  • Sirolimus / analogs & derivatives
  • Stents
  • Thrombectomy
  • Thrombosis / diagnostic imaging
  • Thrombosis / etiology
  • Thrombosis / physiopathology
  • Thrombosis / therapy*
  • Treatment Outcome
  • Vascular Patency

Substances

  • Cardiovascular Agents
  • Metals
  • Everolimus
  • Sirolimus