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Published on: May 19, 2022
Balloon-uncrossable SVG lesion managed with recanalisation of CTO using rotational atherectomy
Nawaz Z Safdar1, Syed Y Naqvi2, Ali M Bhatty3
1Internal Medicine Resident, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, USA.
Insights
Rotational atherectomy successfully restored blood flow in a patient with severe coronary artery disease and chronic total occlusions, offering a new approach for challenging saphenous vein graft interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Saphenous vein grafts (SVGs) are crucial for coronary artery bypass grafting (CABG) in severe coronary artery disease.
- Graft re-stenosis and chronic total occlusions (CTOs) in native vessels pose significant challenges.
- Revascularization of native vessels supplying SVGs is infrequently successful.
Purpose of the Study:
- To evaluate the efficacy of rotational atherectomy in restoring blood flow to a severely diseased native coronary artery.
- To present a case of successful intervention in a patient with complex coronary artery disease and previously bypassed vessels.
Main Methods:
- A patient with a history of CABGs presented with refractory chest pain due to CTOs in the LAD and LCx arteries.
- Severe disease and inability to pass devices into the SVG and LIMA precluded standard intervention.
- Rotational atherectomy was employed to cross the LAD CTO, followed by stenting.
Main Results:
- Successful passage through the LAD CTO using rotational atherectomy was achieved.
- Good coronary blood flow was restored post-stenting.
- The patient remained asymptomatic one year after the procedure.
Conclusions:
- Rotational atherectomy can be an effective alternative strategy when standard devices fail in calcified venous grafts.
- This technique offers a viable option for restoring blood flow in complex coronary artery disease cases with CTOs.
Abstract:
Saphenous vein grafts (SVGs) are frequently used for coronary artery bypass grafting (CABG) of severe coronary artery disease; however, re-stenosis is common. Restoration of blood flow to the SVG is uncommonly achieved via revascularisation of the native vessel. A man in his 70s with previous CABGs presented with prolonged chest pain at rest. The left anterior descending (LAD) and left circumflex arteries had chronic total occlusions (CTO), and the SVG and left internal mammary artery, previously used to bypass the LAD, were severely diseased with sluggish flow and an inability to pass a balloon or microcatheter. Rotational atherectomy was successfully performed to cross the LAD CTO, with good flow post-stenting. He remained asymptomatic one year later. Where management of calcified venous grafts precludes passage with balloon or microcatheter, rotational atherectomy of the native coronary may represent an alternative method of restoring blood flow.
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