Multiple PCI of SVG-LAD and SVG-OM graft vessel in a Bangladeshi patient starting 7 years after

Size: px

Start display at page:

Download "Multiple PCI of SVG-LAD and SVG-OM graft vessel in a Bangladeshi patient starting 7 years after"

Cori Hancock
6 years ago
Views:

1 Multiple PCI of SVG-LAD and SVG-OM graft vessel in a Bangladeshi patient starting 7 years after CABG with and without distal Protection Device Shahabuddin Talukder MBBS, FCPS, D.card Consultant Cardiologist Clinical & Interventional Cardiology Apollo Hospitals Shahab Dhaka U Talukder

2 Pti Patient tprofile HA, a 72 yr old Bangladeshi gentleman CAD Risk factors: HTN, DM, Dyslipidemia Past history of Anterior MI. S/P CABG X PCI to distal SVG to OM-2003 PCI to distal SVG -LAD-2004 PCI to distal SVG-OM-2007 Re-look CAG (5/7/2010) revealed Native TVD with Occluded SVG-RCA. SVG- LAD 80-90% proximal lesion with patent stent distally and also have SVG- OM- 90% tandem lesion in ostio-proximal segment with patent stent distally. Re-look CAG (12/09/2011) showed patent all previous stents both graft vessel but significant lesion in anastomotic site SVG to OM.

3 CAG (5/7/2010)

4 CAG (5/7/2010)shows the ostio proximal plaque of SVG LAD and SVG OM with ihpatent stent distal segments

5 Direct SVG LAD stent by 3.5x 23mm Cypher with distal protection device.

6 2 nd Cypher 35x mm stent covering the ostium deployed at 20ATM

7 Post dilation at overlapping stented segment

8 Withdrawal of distal protection device

9 Proximal SVG OM lesion

10 Direct 4.0 x 28 mm Liberte stent deployed at 20ATM with distal protection ti device.

11 Re look CAG (12/9/2011)shows culprit lesion distal to SVG OM stent at the anastomotic site

12 2.75 x 13 mm Cypher stent deployed at 14 ATM

13 TIMI III III distal flow

14 Discussion Progressive closure of SVG graft 10 12% in 1 st year, 3 5% per yr,50 60% by 10 years SVG intervention is an attractive therapeutic alternative to re operation. Have lower morbility and mortality rate than Re do CABG Limited by No reflow phenomenon, distal emb olization and peri procedural MI. Use of embolic protection device improve the outcome. To do PCI SVGgraft is challenging dissicion. Post CABG commonly presented with multiple graft lesion PCI graft always associated with poor guide support Difficult to deliver devices High thrombus loads

15 Discussion Intra coronary vasodilators ( diltiazem, varapamil, nicardipine) or adenocine and nitro prusside, help from preventing and treating no re flow phenomenon but there is no evidence that they protect MI. ІІb/ІІІa inhibitor don't offer any advantage of no reflow treatment or prevention SVG lesion is more lipid rich,softer and prone to rupture. May lead to an enhanced inflammatory and thrombotic reaction after stent deployment.

16 Although most patients with recurrent angina due SVG stenosis can be manage medically, catheterization should be performed at the earliest signs of recurrent ischemia i to detect critical graft lesions that can be treated before the irreversible loss of the graft. DES in SVG PCI is safe and is not associated with excess mortality rate compared with BMS Membrane cover stent(ptfe), Drug balloon(deb) may be alternative ti option to have comparable efficacy and improved long term safety in DES era.

17 Use of embolic protection device( distal filter, proximal/ distal occlusionaspiration device) in suitable lesion, direct stenting and avoiding stent over expansion/ post dilatation decreases the risk of distal embolization thereby improved short term procedural safety and mortality; however long term results are not still similar to those of native vessels PCI.

18 Conclusion * Repeated PCI successfully done in this patient as Native vessels are diffusely diseased d and totally occluded from ostio proximal segment so native vessel PCI wasn t good option Re do CABG was refused by the patient( reop. Done due to LIMA crash in first CABG) * No short & long term difference in BMS Vs. DES Distal protection device was helpful to prevent NO re flow phenomenon.

THE PROXIMAL LAD VIA SVG IN PATIENT AFTER CABG. Cardiovascular department Tokyo, Japan

SUCCESSFUL RECANALIZATION OF CTO IN THE PROXIMAL LAD VIA SVG IN PATIENT AFTER CABG St. Lukes International Hospital Cardiovascular department Tokyo, Japan Hitoshi Anzai MD M.D. Present illness 64 YRS-OLD