open access

Vol 14, No 3 (2019)
Case Reports
Published online: 2019-07-04
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‘Pharmacological distal protection’ with intragraft administration of diltiazem as pre-treatment during saphenous vein graft intervention

Santosh Kumar Sinha, Siddarth Samrat, Kumar Himanshu, Mahmodulla Razi
DOI: 10.5603/FC.2019.0061
·
Folia Cardiologica 2019;14(3):289-293.

open access

Vol 14, No 3 (2019)
Case Reports
Published online: 2019-07-04

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.

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.
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Keywords

embolic protection devices; intragraft diltiazem; percutaneous coronary intervention; coronary artery bypass graft

About this article
Title

‘Pharmacological distal protection’ with intragraft administration of diltiazem as pre-treatment during saphenous vein graft intervention

Journal

Folia Cardiologica

Issue

Vol 14, No 3 (2019)

Pages

289-293

Published online

2019-07-04

DOI

10.5603/FC.2019.0061

Bibliographic record

Folia Cardiologica 2019;14(3):289-293.

Keywords

embolic protection devices
intragraft diltiazem
percutaneous coronary intervention
coronary artery bypass graft

Authors

Santosh Kumar Sinha
Siddarth Samrat
Kumar Himanshu
Mahmodulla Razi

References (15)
  1. Blachutzik F, Achenbach S, Troebs M, et al. Angiographic Findings and Revascularization Success in Patients With Acute Myocardial Infarction and Previous Coronary Bypass Grafting. Am J Cardiol. 2016; 118(4): 473–476.
  2. Leborgne L, Cheneau E, Pichard A, et al. Effect of direct stenting on clinical outcome in patients treated with percutaneous coronary intervention on saphenous vein graft. Am Heart J. 2003; 146(3): 501–506.
  3. Levine G, Bates E, Blankenship J, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Circulation. 2011; 124(23).
  4. Baim DS, Wahr D, George B, et al. Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) Trial Investigators. Randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation. 2002; 105(11): 1285–1290.
  5. Lee CH, Low A, Tai BC, et al. Pretreatment with intracoronary adenosine reduces the incidence of myonecrosis after non-urgent percutaneous coronary intervention: a prospective randomized study. Eur Heart J. 2007; 28(1): 19–25.
  6. Desmet WJR, Dens J, Coussement P, et al. Does adenosine prevent myocardial micronecrosis following percutaneous coronary intervention? The ADELINE pilot trial. ADEnosine Limit myocardial Necrosis. Heart. 2002; 88(3): 293–295.
  7. Marzilli M, Orsini E, Marraccini P, et al. Beneficial effects of intracoronary adenosine as an adjunct to primary angioplasty in acute myocardial infarction. Circulation. 2000; 101(18): 2154–2159.
  8. Stoel MG, Marques KMJ, de Cock CC, et al. High dose adenosine for suboptimal myocardial reperfusion after primary PCI: A randomized placebo-controlled pilot study. Catheter Cardiovasc Interv. 2008; 71(3): 283–289.
  9. Fischell TA, Carter AJ, Foster MT, et al. Reversal of "no reflow" during vein graft stenting using high velocity boluses of intracoronary adenosine. Cathet Cardiovasc Diagn. 1998; 45(4): 360–365.
  10. Sdringola S, Assali A, Ghani M, et al. Adenosine use during aortocoronary vein graft interventions reverses but does not prevent the slow-no reflow phenomenon. Catheterization and Cardiovascular Interventions. 2000; 51(4): 394–399, doi: 10.1002/1522-726x(200012)51:4<394::aid-ccd4>3.0.co;2-g.
  11. Kaplan BM, Benzuly KH, Kinn JW, et al. Treatment of no-reflow in degenerated saphenous vein graft interventions: comparison of intracoronary verapamil and nitroglycerin. Cathet Cardiovasc Diagn. 1996; 39(2): 113–118.
  12. Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of 'no-reflow' after percutaneous coronary intervention. Circulation. 1994; 89(6): 2514–2518.
  13. Michaels AD, Appleby M, Otten MH, et al. Pretreatment with intragraft verapamil prior to percutaneous coronary intervention of saphenous vein graft lesions: results of the randomized, controlled vasodilator prevention on no-reflow (VAPOR) trial. J Invasive Cardiol. 2002; 14(6): 299–302.
  14. Resnic FS, Wainstein M, Lee MKY, et al. No-reflow is an independent predictor of death and myocardial infarction after percutaneous coronary intervention. Am Heart J. 2003; 145(1): 42–46.
  15. Abbo KM, Dooris M, Glazier S, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol. 1995; 75(12): 778–782.

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