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Covered stent graft for primary PTCA of an aortocoronary vein graft
Timur Timurkaynak1, Haci Ciftci, Atiye Cengel
1Department of Cardiology, Gazi University Medical School, Ankara, Turkey. ttimurkaynak@superonline.com
Insights
Covered stent grafts successfully restored coronary flow in a patient with acute myocardial infarction by preventing distal embolization. Longer stent length is recommended for saphenous vein grafts due to plaque characteristics.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Distal embolization and "no reflow" are significant risks in high-risk patients undergoing interventions for acute myocardial infarction.
- Saphenous vein grafts (SVGs) present unique challenges due to their thrombogenic nature and soft plaque.
Observation:
- A case of acute myocardial infarction in a totally occluded SVG is presented.
- Two covered stent grafts were implanted to restore coronary flow.
Findings:
- The covered stent grafts successfully entrapped thrombus, preventing distal embolization and "no reflow" phenomenon.
- Successful restoration of coronary flow was achieved in a highly thrombogenic milieu.
Implications:
- Covered stent grafts offer a potential solution for managing complex thrombotic lesions in SVGs.
- Stent length selection is critical; it should exceed the lesion length to account for plaque elongation during dilation, especially in soft SVG plaques.
Abstract:
Covered stent graft by entrapping the thrombus between the vessel wall and stent might be helpful in preventing distal embolization and "no reflow" in a high-risk patient cohort. We here present a case with successful restoration of coronary flow in a highly thrombogenic milieu (acute myocardial infarction) with implantation of two covered stent grafts which by entrapping the thrombus avoided the distal embolization and "no reflow" in a totally occluded saphenous vein graft (SVG). However, stent length should be longer than the measured lesion length since choosing the exact diameter will not cover the plaque elongification secondary to the dilation process which is specifically significant in SVGs because of the softness of the plaque.
