TITLE:
Retrograde percutaneous coronary intervention via critically degenerated saphenous vein grafts for chronic total occlusion in native coronary arteries
AUTHORS:
Makoto Sekiguchi, Masao Yamazaki, Masahiko Kurabayashi
KEYWORDS:
Percutaneous Coronary Intervention; Total Occlusion; Saphenous Vein Grafts
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.3,
June
4,
2013
ABSTRACT: We report the case of a 78-year-old woman with saphenous
vein graft (SVG) disease and chronic total occlusion (CTO) in three native
coronary arteries [left anterior descending artery (LAD), left circumflex
artery, and the right coronary artery], who was successfully treated by
percutaneous coronary intervention (PCI) using the retrograde approach via
the critically degenerated SVGs. The patient, a 78-year-old woman, presented
with sudden chest pain and dyspnea. She had previously undergone coronary
artery bypass surgery using SVGs for the three vessels and percutaneous
coronary intervention with sirolimuseluting stent placement in the posterolateral
branch 13 and 3 years ago, respectively. Electrocardiography revealed
ST-segment elevation in leads V1-4, whereas emergent coronary angiography revealed
total occlusion in her native coronary arteries. Primary PCI was scheduled. A
channel dilator was advanced very smoothly and safely into the distal site of
the CTO lesion in the LAD, which showed complete occlusion in the proximal
region, via an SVG that was temporally occluded four days earlier. A reverse
controlled antegrade and retrograde tracking technique was used to successfully
perform percutaneous recanalization. Subsequently, the other two native CTO
lesions protected by critically degenerated SVGs were treated with retrograde
intervention via the SVGs. The retrograde approach via critically degenerated
SVGs is safe, reliable, and fast. If an SVG bypassing the native CTO lesion is
critically degenerated, percutaneous coronary intervention should be performed
via the SVG.