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Percutaneous coronary interventions on vein graft bifurcation lesions presenting as an acute coronary syndrome
Author(s) -
Feghaly Julien,
Muskula Preetham,
Kumar Sundeep,
Helmy Tarek
Publication year - 2021
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.29218
Subject(s) - medicine , ostium , angioplasty , saphenous vein graft , anastomosis , radiology , acute coronary syndrome , percutaneous coronary intervention , stent , cardiology , surgery , percutaneous , lesion , artery , myocardial infarction
Interventions on graft bifurcation lesions are uncommon, especially in the setting of acute coronary syndromes (ACS). We described three cases of graft bifurcation intervention where we tailored our approach based on lesion characteristics, anatomy, and angulation to achieve excellent angiographic and clinical outcomes. In case 1, shared ostia of saphenous vein graft (SVG) to Diagonal (D) and Radial graft to Obtuse Marginal (OM) was severely stenosed. We prioritized the radial arterial graft as it is known to have a longer patency rate over a totally occluded SVG of an undetermined period. We performed provisional stenting of the ostium of the radial artery and balloon angioplasty of the SVG ostium, while stenting the body of the SVG. In case 2 (bifurcation lesion at the anastomosis of SVG to D1 and sequential jump graft to OM), we utilized a V stenting strategy after an embolization protection device (EPD) was deployed in the branch with a suitable landing zone. Kissing balloon dilatation of both the branches was performed both pre‐ and poststenting. In case 3 (bifurcation lesion at SVG to OM and Sequential “T” graft to diagonal), there was >90% angulation between both the grafts. We used “T” stenting strategy in this case. At 2‐year follow‐up, patients had no major adverse cardiovascular events since and remained symptom free.