Vol 14, No 3 (2019)
Case report
Published online: 2019-07-04
‘Pharmacological distal protection’ with intragraft administration of diltiazem as pre-treatment during saphenous vein graft intervention
DOI: 10.5603/FC.2019.0061
Folia Cardiologica 2019;14(3):289-293.
Abstract
Percutaneous coronary intervention (PCI) of vein graft lesions is associated with a high risk of peri-procedural myocardial infarction and greater mortality than routine native coronary intervention. Embolic protection devices have been advocated to reduce the risk of distal embolisation during vein graft PCI.
Here, we report the case of a 72 year-old diabetic male smoker who had coronary artery bypass surgery three years previously who presented with acute coronary syndrome. Repeat coronary angiography revealed patent grafts except for a discrete eccentric critical lesion in ostium of saphenous vein graft to obtuse marginal. The lesion was crossed using a 0.014” runthrough wire (Terumo, Japan). Intragraft diltiazem (5 mg) was administered through the guiding catheter each time before predilatation and stenting (total dose = 30 mg). It was finally stented by deploying a 3.5 × 23 mm Xience Prime everolimus-eluting stent (Abbott, USA) at 13 atm pressure achieving TIMI III flow. He was discharged the next day with acetylsalicylic acid — 75 mg/day, ticagrelor — 90 mg twice daily, atorvastatin — 40 mg/day, metoprolol — 100 mg/day, and ramipril — 5 mg/day. The patient has been doing extremely well since then, with regular follow-ups at our institute.
Keywords: embolic protection devicesintragraft diltiazempercutaneous coronary interventioncoronary artery bypass graft
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