Related Experiment Videos
Intracoronary thrombolysis in the treatment of graft closure immediately after CABG
H L Dauerman1, D E Cutlip, F W Sellke
1Department of Medicine, Beth Israel Hospital, Boston, MA 02215, USA.
Insights
A patient with a hypercoagulable state experienced graft occlusion after coronary artery bypass grafting. Successful percutaneous transluminal coronary angioplasty and thrombolysis restored blood flow, preventing further complications.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Hypercoagulable states increase thrombotic risk, posing challenges for cardiovascular procedures.
- Coronary artery bypass grafting (CABG) is a critical intervention for severe coronary artery disease.
Observation:
- A patient with a hypercoagulable state developed cardiogenic shock and diffuse ECG changes hours post-CABG.
- Catheterization revealed acute thrombotic occlusion of all coronary grafts, including the left internal mammary artery (LIMA) graft.
Findings:
- Percutaneous transluminal coronary angioplasty (PTCA) and thrombolysis with urokinase successfully reopened all occluded grafts.
- The intervention was performed without any bleeding complications.
Implications:
- Early recognition and prompt endovascular intervention can salvage grafts in hypercoagulable patients post-CABG.
- This case highlights the potential of angioplasty and thrombolysis for managing acute graft thrombosis.
Abstract:
A patient with a hypercoagulable state underwent coronary artery bypass grafting and was recovering uneventfully until diffuse electrocardiographic changes and cardiogenic shock developed within hours of the operation. Because of severe hemodynamic compromise on high-dose inotropic drugs and intraaortic balloon pump support, she was taken to the catheterization laboratory, where the patient was discovered to have thrombotic occlusion of all grafts, including the left internal mammary artery to the left anterior descending artery. Multiple graft percutaneous transluminal coronary angioplasty and thrombolysis with urokinase successfully opened the grafts, without bleeding complication. Anastomoses were all free of significant anatomic lesion. She has remained free of cardiac symptoms for 3.5 years after operation.