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Percutaneous Coronary Intervention in a Patient with Acute Thrombosis of Saphenous Vein Graft and Patent Native Coronary Artery: Which is the Vessel to Approach?

  • Received: 12 June 2015 Accepted: 15 September 2015 Published: 22 September 2015
  • We describe a case of a patient with a clinical history of coronary artery disease, previously treated by coronary surgery and, one year later, by percutaneous coronary intervention plus stenting for sub-occlusive disease of the saphenous vein graft to first obtuse marginal (OM) branch. The patient, admitted to our emergency room with chest pain, nausea, hypotension and diaphoresis, had elevated blood levels of cardiac troponin T and EKG showed elevation of the ST segment in the in lateral leads, suggesting a diagnosis of ST elevated myocardial infarction (STEMI). Thus, coronary angiography was immediately performed, showing the massive thrombosis of the saphenous vein graft previously treated by stenting and the slight patency of the native vessel. We decided to approach the native vessel instead of clashing to the massive thrombus of the saphenous vein graft, overcoming the actual guidelines indications.

    Citation: Marco Ferrone, Anna Franzone, Bruno Trimarco, Giovanni Esposito, Plinio Cirillo. Percutaneous Coronary Intervention in a Patient with Acute Thrombosis of Saphenous Vein Graft and Patent Native Coronary Artery: Which is the Vessel to Approach?[J]. AIMS Medical Science, 2015, 2(4): 310-315. doi: 10.3934/medsci.2015.4.310

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  • We describe a case of a patient with a clinical history of coronary artery disease, previously treated by coronary surgery and, one year later, by percutaneous coronary intervention plus stenting for sub-occlusive disease of the saphenous vein graft to first obtuse marginal (OM) branch. The patient, admitted to our emergency room with chest pain, nausea, hypotension and diaphoresis, had elevated blood levels of cardiac troponin T and EKG showed elevation of the ST segment in the in lateral leads, suggesting a diagnosis of ST elevated myocardial infarction (STEMI). Thus, coronary angiography was immediately performed, showing the massive thrombosis of the saphenous vein graft previously treated by stenting and the slight patency of the native vessel. We decided to approach the native vessel instead of clashing to the massive thrombus of the saphenous vein graft, overcoming the actual guidelines indications.


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    [8] Gaglia MA, Torguson R, Xue Z, et al. (2011) Outcomes of patients with acute myocardial infarction from a saphenous vein graft culprit undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 78(1): 23-29.
    [9] Mehilli J, Pache J, Abdel-Wahab M, et al. (2011) Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet 378(9796): 1071-1078.
    [10] Vermeersch P, Agostoni P, Verheye S, et al. (2007) Increased late mortality after sirolimus-eluting stents versus bare-metal stents in diseased saphenous vein grafts: results from the randomized DELAYED RRISC Trial. J Am Coll Cardiol 50(3): 261-267.
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    [12] Taniwaki M, Räber L, Magro M, et al. (2014) Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts. EuroIntervention 9(12): 1432-1434.
    [13] Kitabata H, Loh JP, Pendyala LK, et al. (2013) Two-year follow-up of outcomes of second-generation everolimus-eluting stents versus first-generation drug-eluting stents for stenosis of saphenous vein grafts used as aortocoronary conduits. Am J Cardiol 112(1): 61-67.
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