Division of Cardiology, Humanitas Gavazzeni, Bergamo, Italy.
Catheter Cardiovasc Interv. 2010 Jun 1;75(7):1051-5. doi: 10.1002/ccd.22413.
Percutaneous treatment of old, degenerated saphenous vein grafts (SVG) is associated with a high likelihood of major adverse cardiac events. When an acute coronary syndrome (ACS) develops in a patient with old SVG, fresh thrombus may superimpose on an old, degenerative atheroma: a sudden increase in the athero-thrombotic burden ensues with consequent, frequent total occlusion of the lumen. In this scenario, transluminal recanalization of the graft is usually associated with the highest chance of distal embolization and no-reflow and positioning of an embolic protection device (EPD) is almost mandatory. However, distal EPD are difficult to place when the vessel is totally occluded and do not completely avoid distal embolization. We report two cases of totally occluded SVG in patients admitted for ACS that were recanalized with the aid of a proximal EPD system with angiographic and clinical success.
经皮治疗陈旧性、退行性大隐静脉移植物（SVG）与发生重大心脏不良事件的高度可能性相关。当陈旧 SVG 的患者发生急性冠脉综合征（ACS）时，新鲜血栓可能会叠加在陈旧、退行性的动脉粥样硬化上：随之而来的是动脉血栓负担的突然增加，导致管腔频繁完全闭塞。在此情况下，移植物的腔内再通通常与远端栓塞和无复流的最高可能性相关，因此几乎必须使用栓塞保护装置（EPD）。然而，当血管完全闭塞时，远端 EPD 难以放置，并且不能完全避免远端栓塞。我们报告了两例因 ACS 入院的完全闭塞 SVG 患者，他们在近端 EPD 系统的辅助下成功进行了血管再通，实现了影像学和临床成功。
