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Proximal protection in recanalization of totally occluded saphenous vein grafts in acute coronary syndrome
Author(s) -
Sganzerla Paolo,
Tavasci Emanuela
Publication year - 2010
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22413
Subject(s) - medicine , thrombus , acute coronary syndrome , percutaneous , occlusion , embolization , cardiology , lumen (anatomy) , saphenous vein graft , surgery , radiology , myocardial infarction , artery
Percutaneous treatment of old, degenerated saphenous vein grafts (SVG) is associated with a high likelihood of major adverse cardiac events. When an acute coronary syndrome (ACS) develops in a patient with old SVG, fresh thrombus may superimpose on an old, degenerative atheroma: a sudden increase in the athero‐thrombotic burden ensues with consequent, frequent total occlusion of the lumen. In this scenario, transluminal recanalization of the graft is usually associated with the highest chance of distal embolization and no‐reflow and positioning of an embolic protection device (EPD) is almost mandatory. However, distal EPD are difficult to place when the vessel is totally occluded and do not completely avoid distal embolization. We report two cases of totally occluded SVG in patients admitted for ACS that were recanalized with the aid of a proximal EPD system with angiographic and clinical success. © 2010 Wiley‐Liss, Inc.