Background
Percutaneous interventions for safenous vein grafts (SVGs) carry higher risk of no-reflow. The emboli protection devices may be used in this setting. However, these devices are not utilisied in many cases of ST-elevation myocardial infarction (STEMI). We report that 64-year old man history of coronary bypass surgery presented with inferior STEMI. Coronary angiography (CAG) revealed proximal total occlusion of SVG.
Method
0.014-inch floppy guidewire was passed through the total occlusion of SVG. Thrombus aspiration was performed to attenuate thrombus burden, and better characterize SVG anatomy by avoiding unnecessary balloon angioplasty. Despite successful retrieval of macroscopic thrombus, no-reflow occurred. Intracoronary tirofiban bolus was started. We decided to use higher-dose adenosine for relieving microvascular obstruction by using manual thrombus aspiration catheter. Because of the short half life of adenosine, we firstly positioned thrombus aspiration catheter distal coronary artery to give adenosine efficiently into the microvascular bed. After higher-dose adenosine with the total dose of 5 mg, blood aspirations via aspiration catheter were employed from distal to the proximal part of SVG. CAG revealed resolution of no-reflow. Finally, 2.5×20 mm sized drug eluting stent was deployed to stenosis at the distal anastomosis.
Method
0.014-inch floppy guidewire was passed through the total occlusion of SVG. Thrombus aspiration was performed to attenuate thrombus burden, and better characterize SVG anatomy by avoiding unnecessary balloon angioplasty. Despite successful retrieval of macroscopic thrombus, no-reflow occurred. Intracoronary tirofiban bolus was started. We decided to use higher-dose adenosine for relieving microvascular obstruction by using manual thrombus aspiration catheter. Because of the short half life of adenosine, we firstly positioned thrombus aspiration catheter distal coronary artery to give adenosine efficiently into the microvascular bed. After higher-dose adenosine with the total dose of 5 mg, blood aspirations via aspiration catheter were employed from distal to the proximal part of SVG. CAG revealed resolution of no-reflow. Finally, 2.5×20 mm sized drug eluting stent was deployed to stenosis at the distal anastomosis.
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