Treatment of In stent restenosis at saphenous vein graft

- Operator : Seung-Jung Park

Treatment of In stent restenosis at saphenous vein graft
- Operator: Seung-Jung, Park, MD
Clinical History

A 75 year-old male was presented with effort-related chest pain for three months. In past medical history, he had got bypass surgery 13 years ago; LIMA to LAD, saphenous vein graft (SVG) to posterior descending artery(PDA), SVG to posterior lateral(PL) branch, SVG to ramus and diagonal branch. One year after surgery, SVG-PL graft was occluded and we did PCI at native mRCA with two BMS stents. 2 years ago, we found out total occlusion at SVG to ramus and tight stenosis at SVG to PDA. We did PCI at SVG to PDA lesion with two Cypher stents (3.0*23mm).
Recently, we did non-invasive test because he complained newly developed chest pain. In thallium scan, there was large sized reversible perfusion defect in his RCA territory and in Treadmil test, the result was positive at stage 4. His risk factors were DM and hypertension.

Coronary angiographic findings

1. Right coronary angiogram showed diffuse intermediate stenosis at pRCA and tight stenosis at mdRCA. There was no significant change compared to previous angiogram performed 2-years ago.( Movie 1)
2. Left coronary angiogram showed diffuse severe stenosis with mLAD total occlusion. which was same finding with previous angiogram. ( Movie 2).
3. LIMA graft to LAD was patent ( Movie 3), however, there was tight tubular stenosis at proximal part of previous fractured stent in SVG to PDA. ( Movie 4).

Procedure

Saphenous vein graft was engaged with a 7 Fr JR 4 guiding catheter with side hole. A 0.014 inch BMW wire was inserted into SVG and IVUS exam was performed.( Movie 5) We predilated with Voyager NC 3.0*15mm upto 20 atm and we performed stenting with Endeavor Resolute stent 3.0*15mm at proximal part of previous stent.( Movie 6) We did high-pressure balloon dilatation with Voyager NC 3.0*15mm upto 24atm and Quantum 3.5*8mm upto 20 atm. Final coronary angiogram with IVUS exam showed successful PCI at ISR lesion in SVG ( Movie 7, Movie 8).

Comments

  • hosam e ebrahim 2011-01-03 thanks for your efforts
  • maher 2011-01-16 GOOD JOB , BUT I THINK (3.5 *15) STENT IS BETTER.

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