Successful treatment of coronary artery steal with an Amplatzer Vascular Plug 4.

摘要

A 73 year old man presented to the cardiology clinic with troublesome chronic stable angina (CCS grade III/1V). Over 30 years previously he had superior vena cava obstruction due to idiopathic fibrosis treated with stenting and caval bypass, both of which ultimately failed. Myocardial perfusion scanning demonstrated a reversible perfusion defect in the inferior wall. Coronary angiography {Panel A) demonstrated a large vessel originating from a left dominant circumflex artery with otherwise normal coronary arteries. CT coronary angiography was undertaken and demonstrated that the vessel was a coropulmonary collateral (Panel B). This was likely to be causing coronary artery steal. In view of ongoing symptoms despite medical therapy the decision was made to close this vessel percutaneously. Initial attempts via the radial approach were unsuccessful due to poor guide support but a repeated attempt via the femoral artery was successful. A 7F AL 2 guiding catheter was used, a whisper wire (Abbott, UK) was placed in the vessel and a 4 F delivery catheter was advanced into the vessel (Panel C). An Amplatzer Vascular Plug 4, (image courtesy of AGA medical corporation) (Panel D) was subsequently deployed (Panel E) and occlusion of the vessel after several minutes was confirmed by repeat angiography (Panel F). The patient experienced mild discomfort following the procedure but was otherwise well and discharged home the following morning.