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Percutaneous coronary angioplasty of radial artery conduits
M Zimarino1, N Acciai, L Cappelletti
1Servizio di Emodinamica, Ospedale R. Calai, Gualdo Tadino, PG.
Insights
Percutaneous treatment of diseased radial artery grafts offers a viable option for complete arterial myocardial revascularization. This approach successfully addressed graft issues, preventing restenosis and improving outcomes in two patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Complete arterial myocardial revascularization is desirable for long-term graft patency.
- Percutaneous angioplasty is standard for recurrent ischemia post-bypass but less studied for arterial grafts.
Observation:
- Two cases of percutaneous treatment for diseased radial artery (RA) grafts are presented.
- The first case involved stenting a diseased RA graft with spasm, treated successfully with calcium antagonists.
- The second case utilized stenting and kissing-balloon angioplasty for LAD artery and RA graft stenosis.
Findings:
- The first patient showed no restenosis at two-year follow-up after RA graft stenting.
- The second patient's proximal LAD occlusion and stenotic RA distal anastomosis were successfully treated.
- Intracoronary calcium antagonists effectively reversed diffuse RA graft spasm resistant to nitrates.
Implications:
- Percutaneous treatment is a feasible strategy for managing diseased radial artery grafts.
- This approach can achieve successful revascularization and prevent restenosis in specific arterial graft complications.
- Further research is warranted to establish the role of percutaneous interventions in arterial graft management.
Abstract:
The higher long-term patency of internal mammary artery grafts has stimulated the search for alternative conduits in order to achieve a complete arterial myocardial revascularization. Percutaneous angioplasty is often the preferred strategy for the treatment of recurrent ischemia in patients who previously underwent bypass surgery, but there is limited experience in the treatment of arterial grafts. We describe two cases of percutaneous treatment of diseased radial artery (RA) grafts. In the first case, two disarticulated stents were deployed through an RA graft: half stent inside the anastomosis to the left anterior descending (LAD) artery, and half stent in the distal LAD artery. Diffuse spasm of the RA graft, resistant to ic nitrates, was successfully reversed after ic calcium antagonists. Absence of restenosis was confirmed two years later. In the second case, after simultaneous catheterization of both the left coronary artery and RA graft, two long stents were implanted in the LAD artery and a final "reversed" kissing-balloon dilation through the stent struts was performed; four months later the patient showed proximal occlusion of the LAD artery and the stenotic RA distal anastomosis was successfully dilated.