Percutaneous coronary interventions on vein graft bifurcation lesions presenting as an acute coronary syndrome

Interventions on graft bifurcation lesions are uncommon, especially in the setting of acute coronary syndromes (ACS). We described three cases of graft bifurcation intervention where we tailored our approach based on lesion characteristics, anatomy, and angulation to achieve excellent angiographic a...

Full description

Saved in:
Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2021-04, Vol.97 (5), p.E680-E685
Main Authors: Feghaly, Julien, Muskula, Preetham, Kumar, Sundeep, Helmy, Tarek
Format: Article
Language:English
Subjects:
ACS/NSTEMI
Acute coronary syndromes
Anastomosis
Angioplasty
Balloon treatment
complex PCI
coronary artery disease
coronary bypass grafts
Embolization
interventional devices/innovation
Lesions
percutaneous coronary intervention
Stents
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Interventions on graft bifurcation lesions are uncommon, especially in the setting of acute coronary syndromes (ACS). We described three cases of graft bifurcation intervention where we tailored our approach based on lesion characteristics, anatomy, and angulation to achieve excellent angiographic and clinical outcomes. In case 1, shared ostia of saphenous vein graft (SVG) to Diagonal (D) and Radial graft to Obtuse Marginal (OM) was severely stenosed. We prioritized the radial arterial graft as it is known to have a longer patency rate over a totally occluded SVG of an undetermined period. We performed provisional stenting of the ostium of the radial artery and balloon angioplasty of the SVG ostium, while stenting the body of the SVG. In case 2 (bifurcation lesion at the anastomosis of SVG to D1 and sequential jump graft to OM), we utilized a V stenting strategy after an embolization protection device (EPD) was deployed in the branch with a suitable landing zone. Kissing balloon dilatation of both the branches was performed both pre‐ and poststenting. In case 3 (bifurcation lesion at SVG to OM and Sequential “T” graft to diagonal), there was >90% angulation between both the grafts. We used “T” stenting strategy in this case. At 2‐year follow‐up, patients had no major adverse cardiovascular events since and remained symptom free.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.29218