Case Title
Veingraft angioplasty with protection device
Case History
10,000 Saphenous vein grafts close down every year. 50-70% of the vein grafts degenerate in 5-7 TRS time. Almost 90% of vein grafts degenerate in 10 yrs time.
Problems in saphenous vein graft:
- SVGS More Than 3 yrs old embolise Much More Commonly.
- Since they arise from ascending aorta good back up support needed.
- Often the distal coronary arteries beyond the anastomatic site is torterous requiring hydrophilic wire like choice pt extra support.
- Distal protectiion device and filters are often essential.
- Newly designed cloth covered stent tm brand "symbiot" is reported to have much smaller incidence of distal embolism.
Case: MR A. Gupta underwent bypass surgery 10 yrs ago hypertension+, diabetic+.
Investigation Reports
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Click on the thumbnail images to see the videos
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Notice the guide catheter AR2 (scimed) for coaxial alignment very tight almost 90% eccentric stenosis in the MID SEG of the graft supplying PDA &PLV branch of RCA. |
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EPI filter device is positioned approx 4cms away from the site of the lesion. 80-120 micron pores of the device permit free flow of blood filter emboli going to distal circulatory bed. |
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Direct implantation of the EPTFE covered nitinol stent symbiot 4x31mm length is shown being positioned at the site of the lesion. |
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The stent is deployed showing a very small waste at the site of the lesion.
Note nitinol stents are self expanding and grow over a period of time. |
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3.5x15 mm stommer balloon moderate pressured dilation (7atm). Although it is not mandatory to do post stent deployment dilatation, in a cloth covered stent this can be safely achieved. |
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Shows excellent results with a 0% residual stenosis at the site of the lesion. |
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Shows advancement of retrival sheath. |
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Shows the final results.
Note: There is no evidence of either slow flow or distal embolisation. Immediate result is very good and patient is symptom free. |
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Comments
Cloth covered stents and distal protection device have been very useful in preventing slow flow and distal embolisation in vein graft interventions. Unfortunately distal embolisatio is to be managed pharmalogically only and even surgical treatment is inapplicable. Even cloth covered stents have been reported to have low incidences of restenosis (reported restenosis with symbiot is only 7% whereas reported restenosis with wallstent which isnitinol stent without cloth covering is 27%. Larger trials and data analysis would be needed for assessing long term benefits.
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An approach to markedly tortuous lesion. Dec 24, 2003
Angioplasty standby for failed bypass surgery. Dec 2, 2003
Treatment of instent restenosis. Nov 15, 2003
Veingraft angioplasty with protection device. Nov 1, 2003
Complex angioplasty in tortuous vessels. Oct 16, 2003
Angioplasty & Stenting in tortuous vessels. Oct 1, 2003
60 yr. Old man with a History of Multiple Coronary Grafts Sep 15, 2003
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Courtesy
Dr. A.B. Mehta
Director Of Cardiology,
Jaslok Hospital,
Mumbai, India.
Website: http://www.drabmehta.com
Email: drabmehta@cardiovalens.com
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