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Related Experiment Video

Updated: May 5, 2026

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

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Unmasking Culprit Complex Infero-Posterior STEMI: Navigating Ad Hoc RCA CTO PCI.

Maruf Sarwar¹, Stephen D Adedokun², Keonmin Hwang³

¹Section of Internal Medicine, White River Health, Batesville, Arkansas, USA.

JACC. Case Reports

|January 31, 2025

Summary

This case report details a unique ST-segment elevation myocardial infarction caused by an occluded coronary artery graft. Treatment focused on revascularizing the native vessel due to extensive thrombus burden.

Keywords:

ST-segment elevation myocardial infarction ad hoc CTO PCI advanced interventional techniques chronic total occlusion collateral circulation coronary artery bypass graft door-to-balloon time dual angiography graft occlusion graft thrombosis infero-posterior myocardial infarction percutaneous coronary intervention retrograde revascularization reverse CART technique right coronary artery right posterolateral branch occlusion saphenous vein graft occlusion stenting thrombectomy tip-in technique

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Area of Science:

Interventional Cardiology
Cardiovascular Medicine
Acute Coronary Syndromes

Background:

ST-segment elevation myocardial infarction (STEMI) necessitates prompt reperfusion to preserve myocardial tissue.
Coronary artery bypass grafting (CABG) is a common treatment for coronary artery disease, but grafts can occlude.
Occluded grafts with significant thrombus present complex challenges for revascularization.

Observation:

A patient presented with STEMI attributed to a thrombosed, occluded coronary artery bypass graft.
The occluded graft contained an extensive thrombus burden, complicating direct intervention.
A strategic decision was made to pursue revascularization of the native coronary artery instead of the graft.

Findings:

Successful revascularization of the chronically occluded native vessel was achieved.
This approach circumvented the challenges posed by the occluded graft and thrombus.
The case demonstrates an alternative strategy in complex STEMI management.

Implications:

This case highlights the importance of considering native vessel revascularization in STEMI patients with occluded grafts.
Advanced interventional techniques and strategic decision-making are crucial for managing complex thrombotic coronary lesions.
Such cases expand the understanding of treatment options for myocardial infarction in the context of prior revascularization.