Slides

Degenerative Saphenous Vein Graft Intervention

- Operator : Barry D. Rutherford

Degenerative Saphenous Vein Graft Intervention
- Operators: Barry D. Rutherford, MD, Joo-Young Yang, MD
Clinical Information

- Relevant clinical history and physical exam:
A 64-year-old man was admitted with recently developed effort chest pain. Sixteen years ago, CABG was done for severe multivessel disease at other hospital. He was referred for chest pain and abnormal noninvasive test. ECG showed non-specific finding, and biomarker was within normal range.

- Relevant test results prior to catheterization:
Treadmil test revealed ST depression at stage 2 and echocardiography revealed ischemic insults on RCA and LCX territory with low EF (=45%).

- Relevant angiography findings:
Coronary angiogram showed a significant stenosis of native coronary artery and significant stenosis of graft to LAD and diagonal branch (Figure 1, Figure 2)
Interventional Management
- Procedural step:
An 8F sheath was inserted through right femoral artery and graft ostium was engaged with an 8F LCB catheter. Two 0.014 inch BMW guidewire was inserted into both graft vessels. Predilation of graft to LAD was achieved with a 1.5 x 15 mm Maverick balloon. IVUS examination showed heavy degenerative plaque in both graft lesions (Figure 3, Figure 4). Therefore, we decided to use distal protection device, but it is impossible to cross the lesion. During glycoprotein IIb/IIIa receptor blockade, 3.0 x 18 mm Xience stent was deployed at the graft to LAD (Figure 5) and 3.0 x 15 mm Xience stent was deployed at the graft to diagonal branch (Figure 6). Additional balloon was performed with a 3.0 x 12 mm Quantum balloon. Final angiogram showed a well-expanded stents without residual narrowing (Figure 7)

Leave a comment

Sign in to leave a comment.