Retrograde application of the buddy wire technique

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Coronary artery bypass grafting (CABG) is a common surgical procedure for severe coronary artery disease.
• Graft failure, including anastomotic strictures, can occur post-CABG, leading to symptom recurrence.
• Radial artery grafts are increasingly used in CABG procedures.

Observation:

• An 85-year-old male presented with progressive exertional dyspnea 18 months post-CABG.
• Coronary angiography identified a critical anastomotic stricture involving a radial artery graft to the first diagonal branch.
• The patient had undergone surgery for critical three-vessel coronary artery disease.

Findings:

• Percutaneous coronary intervention (PCI) was performed to address the anastomotic stricture.
• A retrograde "buddy" wire technique was successfully employed during the PCI procedure.
• This intervention aimed to restore graft patency and alleviate the patient's symptoms.

Implications:

• The case highlights a potential complication of radial artery grafts used in CABG.
• Successful retrograde PCI with a "buddy" wire technique offers a viable treatment option for complex anastomotic strictures.
• This approach may improve outcomes for patients experiencing graft-related symptoms after bypass surgery.