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Multiple myocardial infarctions associated with atheromatous emboli after PTCA of saphenous vein grafts. A
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Percutaneous transluminal coronary angioplasty (PTCA) of saphenous vein grafts can lead to atheromatous embolization. This study found a higher incidence of myocardial infarction and death due to embolism in patients undergoing this procedure.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is an alternative to repeat coronary bypass grafting for stenotic saphenous vein grafts.
- Atheromatous embolization is a known complication of PTCA in saphenous vein grafts, occurring at a higher rate than in native coronary vessels.
Purpose of the Study:
- To investigate the incidence and consequences of atheromatous embolization during saphenous vein graft angioplasty.
- To evaluate the association between angioplasty-related embolism and adverse outcomes such as myocardial infarction and mortality.
Main Methods:
- Retrospective review of 98 patients undergoing elective saphenous vein graft angioplasty.
- Clinical data collection including procedural complications, serum creatine kinase levels, and patient outcomes.
- Autopsy findings in deceased patients to confirm the presence of atherosclerotic emboli.
Main Results:
- Five patients (5.1%) experienced non-Q-wave myocardial infarction post-procedure.
- Atheroembolism was suspected in four patients during the procedure.
- Two patients died; autopsy revealed widespread atherosclerotic emboli in coronary arteries and evidence of prior infarcts.
Conclusions:
- Saphenous vein graft angioplasty carries a significant risk of atheromatous embolization, leading to myocardial infarction and mortality.
- Both angioplasty-induced and ongoing, recurrent atheroembolism may contribute to adverse outcomes in older vein grafts.
- These findings highlight the need for strategies to mitigate embolic risk during saphenous vein graft interventions.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) of stenotic saphenous vein grafts is less invasive than repeat coronary bypass grafting; however, this procedure is complicated by atheromatous embolization in 2.5%-3.0% of cases, an incidence significantly higher than in angioplasty of native coronary vessels. We reviewed the cases of 98 patients who underwent elective saphenous vein graft angioplasty at our institution. Five patients (5.1%) had non-Q-wave myocardial infarctions after the procedure, documented by elevated serum creatine kinase. In four, atheroembolism was suspected during the procedure. Two patients died, and autopsy showed that both had multiple atherosclerotic emboli to the distal epicardial coronary artery supplied by the vein graft. In addition, multiple infarcts of varying age, some clearly antedating the angioplasty procedure, were identified. These findings suggest that both ongoing, recurrent atheroembolism as well as angioplasty-related embolism may occur in older vein grafts.