Totally occluded SVG and radial artery grafts: Is there a subset where angioplasty and stenting would help?

摘要

Introduction: Angioplasty and stenting (PCI) gives good results fordiseased Saphenous Vein Grafts (SVG) but is disappointing inoccluded grafts, primarily owing to ‘‘clot clogging of the tributary-lacking conduits’’. In fact, PCI is considered a contraindicationin totally occluded SVGs. However, recently occluded grafts couldhave a better chance of good result with PCI; we report a smallseries of such cases.Case report: Four patients, all male, who underwent CABG surgerymore than a decade ago (10.5–19.5 years) presenting with Non-STelevation Myocardial Infarction (NSTEMI). Two patients underwentCAG elsewhere and were referred here for SVG angioplastyfor critical 90% stenosis in the proximal graft to OM and RCA,respectively. Two others underwent CAG in our center and hadcritical proximal graft stenosis (one SVG to OM and the other wasradial artery graft to OM).All underwent transfemoral procedure. Initial angiography shotsrevealed proximally occluded grafts.The time interval betweenCAGand admission for PCI was 3–14 days. In view of continuing anginalsymptoms, absence of other disease to account for the symptoms,awareness of prior anatomy of SVG and disease, and quite shorthistory after possible total occlusion, itwasdecided to go ahead withPCI of the occluded grafts. Minimally invasive ‘‘primary PCI-like’’technique was used in all and was successful and uncomplicated.Drug Eluting Stents were used. Slow-flow and no-flow were notencountered in any. Post PCI, patients had good symptomatic relief.Conclusion: Even though PCI is considered a contraindication fortotally occluded SVGs, there is a subset of recently occluded grafts,which respond to PCI with good outcomes. Use of ‘‘primary PCIlike’’techniques helps in preventing or minimizing slow-flow andno-flow.