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Successful Stent Delivery Through a Slaloming Coronary Path
Konstantinos Aznaouridis1, Maria Bonou, Konstantina Masoura
11st Department of Cardiology, Hippokration Hospital, 114 Vas. Sofias Avenue, 11527 Athens, Greece. conazna@yahoo.com.
Insights
This study presents a guide catheter support technique for complex percutaneous coronary intervention (PCI) in saphenous vein grafts. The method uses deep guide catheter intubation and a buddy wire for stent delivery, offering a safer alternative to complex procedures.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Refractory angina often requires complex percutaneous coronary intervention (PCI).
- Saphenous vein grafts (SVGs) present unique challenges for PCI due to tortuosity and sequential anastomoses.
- Treating critical stenosis in SVG lesions necessitates advanced catheter manipulation techniques.
Observation:
- A critical stenosis was identified in the retrograde limb of a first marginal branch within a tortuous SVG.
- Stent delivery required navigating sequential angulations, demanding enhanced guide catheter support.
Findings:
- A novel technique involving deep guide catheter intubation into the SVG and use of a buddy wire was successfully employed.
- This maneuver provided sufficient support for stent delivery, proving effective and safer than the double guide-catheter extension technique.
Implications:
- This method offers a cost-effective and safer alternative for complex SVG interventions.
- Careful guide catheter selection and pressure waveform monitoring are crucial to prevent graft complications during the procedure.
Abstract:
A 66-year-old man with refractory angina was admitted for percutaneous coronary intervention (PCI) through a tortuous saphenous vein graft sequentially anastomosed with a diagonal and a first marginal branch. Our target was a critical stenosis at the retrograde limb of the first marginal proximal to saphenous vein graft anastomosis. Stent delivery to our target lesion mandated tracking through sequential angulations. In this case, we enhanced the support of the guide catheter and delivered a stent on the retrograde limb of the first marginal branch with very deep intubation of the guide catheter into the saphenous vein graft and use of a buddy wire, which is a cheaper and relatively safer maneuver than complex techniques such as the double guide-catheter extension technique. Proper selection of the type and size of the guide catheter and meticulous attention to the pressure waveform in order to avoid ischemia or dissection of the graft is mandatory during this technique.
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