open access

Vol 14, No 5 (2019)
Case Reports
Published online: 2019-10-31
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Percutaneous angioplasty of venous Y-bypass-graft in patient with unstable angina: Y-bypass graft bifurcation lesions remain a challenge

Piotr Szolc, Łukasz Niewiara, Elżbieta Ostrowska-Kaim, Krzysztof Żmudka, Jacek Legutko, Bartłomiej Guzik
DOI: 10.5603/FC.2019.0102
·
Folia Cardiologica 2019;14(5):504-508.

open access

Vol 14, No 5 (2019)
Case Reports
Published online: 2019-10-31

Abstract

71 years-old patient with history of CABG was admitted to Department of Interventional Cardiology, John Paul II Hospital, Cracow with acute coronary syndrome – unstable angina. The coronary angiography revealed significant narrowing of bifurcated venous bypass graft as the last remaining vessel. After qualification by the Heart Team he underwent percutaneous coronary angioplasty of venous bypass with implantation of self-apposing sirolimus-eluting stent (Stentys). Technical aspects of procedure such as usage of left ventricle assist device, additional imaging (IVUS), type of approach, stent and protection of vessel were considered in this manuscript. Patient with numerous co-morbidities and severely decreased function of left ventricle was rather candidate for percutaneous revascularization. 8 months later patient had implanted implantable cardioverter-defibrillator in primary prevention of sudden cardiac death due to symptomatic chronic heart failure with reduced ejection fraction. Discussion raises the topic of long-term effectiveness of angioplasty in these group of patients. Myocardial revascularization in patient with severe symptoms and diseased last remaining vessel should be obligatory, however multiple comorbidities increases the risk of cardiac surgery as well as percutaneous angioplasty. Critical question is: to treat invasively or with optimal medical treatment?

Abstract

71 years-old patient with history of CABG was admitted to Department of Interventional Cardiology, John Paul II Hospital, Cracow with acute coronary syndrome – unstable angina. The coronary angiography revealed significant narrowing of bifurcated venous bypass graft as the last remaining vessel. After qualification by the Heart Team he underwent percutaneous coronary angioplasty of venous bypass with implantation of self-apposing sirolimus-eluting stent (Stentys). Technical aspects of procedure such as usage of left ventricle assist device, additional imaging (IVUS), type of approach, stent and protection of vessel were considered in this manuscript. Patient with numerous co-morbidities and severely decreased function of left ventricle was rather candidate for percutaneous revascularization. 8 months later patient had implanted implantable cardioverter-defibrillator in primary prevention of sudden cardiac death due to symptomatic chronic heart failure with reduced ejection fraction. Discussion raises the topic of long-term effectiveness of angioplasty in these group of patients. Myocardial revascularization in patient with severe symptoms and diseased last remaining vessel should be obligatory, however multiple comorbidities increases the risk of cardiac surgery as well as percutaneous angioplasty. Critical question is: to treat invasively or with optimal medical treatment?
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Keywords

angioplasty, revascularization, coronary artery disease, heart failure, venous bypass, bifurcation

About this article
Title

Percutaneous angioplasty of venous Y-bypass-graft in patient with unstable angina: Y-bypass graft bifurcation lesions remain a challenge

Journal

Folia Cardiologica

Issue

Vol 14, No 5 (2019)

Pages

504-508

Published online

2019-10-31

DOI

10.5603/FC.2019.0102

Bibliographic record

Folia Cardiologica 2019;14(5):504-508.

Keywords

angioplasty
revascularization
coronary artery disease
heart failure
venous bypass
bifurcation

Authors

Piotr Szolc
Łukasz Niewiara
Elżbieta Ostrowska-Kaim
Krzysztof Żmudka
Jacek Legutko
Bartłomiej Guzik

References (7)
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  2. Wadey K, Lopes J, Bendeck M, et al. Role of smooth muscle cells in coronary artery bypass grafting failure. Cardiovasc Res. 2018; 114(4): 601–610.
  3. Bonzel T, Schächinger V, Dörge H. Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI. Clin Res Cardiol. 2016; 105(5): 388–400.
  4. Guzik B, Niewiara Ł, Fila M, et al. Heart Team decision retention and outcome of patients with multivessel coronary artery disease. Przegl Lek. 2018; 2: 64–67.
  5. Cleland JGF, Calvert M, Freemantle N, et al. The Heart Failure Revascularisation Trial (HEART). Eur J Heart Fail. 2011; 13(2): 227–233.
  6. Chen KJ, Lee WL, Liu TJ, et al. “DK crush” technique for a tightly stenosed conjoined SVG lesion in a patient with acute coronary syndrome and cardiogenic shock. Acta Cardiol Sin. 2015; 31(3): 253–256.
  7. Karalis I, Kochiadakis G, Igoumenidis N, et al. The "crush" technique as a therapeutic approach for a bifurcation lesion in a saphenous venous graft. Hellenic J Cardiol. 2010; 51(4): 368–373.

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