Takagi Yusuke, Sugi Masafumi, Hanawa Kenichiro, Shimokawa Hiroaki
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Department of Cardiology, Iwaki Kyoritsu General Hospital, Fukushima, Japan.
J Cardiol Cases. 2009 Nov 12;1(2):e112-e115. doi: 10.1016/j.jccase.2009.10.001. eCollection 2010 Apr.
Although percutaneous coronary intervention (PCI) is one of the most suitable treatment options in patients with acute coronary syndrome (ACS), PCI for ACS patients with occluded saphenous vein graft (SVG) remains challenging. An 80-year-old man with previous coronary artery bypass grafting (CABG) was admitted with the diagnosis of ACS. Emergent coronary angiography showed a total occlusion of SVG to the left circumflex coronary artery (LCx) with large thrombus burden. Because of concern about serious distal embolization, we subsequently performed primary PCI for the occluded native LCx using a combined antegrade and retrograde approach with the SVG as an access conduit. Successful crossing of the native LCx was achieved by retrograde wire through the SVG, and finally recanalization and stent placement was done. A retrograde approach for chronic total occlusion of coronary artery has become more popular during recent years with encouraging results. This novel technique may provide an additional therapeutic option even in ACS patients with previous CABG.
尽管经皮冠状动脉介入治疗（PCI）是急性冠状动脉综合征（ACS）患者最合适的治疗选择之一，但对于合并隐静脉桥血管（SVG）闭塞的ACS患者，PCI治疗仍具有挑战性。一名有冠状动脉旁路移植术（CABG）史的80岁男性因ACS诊断入院。急诊冠状动脉造影显示，左旋支冠状动脉（LCx）的SVG完全闭塞，血栓负荷大。由于担心严重的远端栓塞，我们随后以SVG为入路导管，采用顺行和逆行联合入路对闭塞的自身LCx进行了直接PCI。通过逆行钢丝穿过SVG成功穿过自身LCx，最终完成了再通和支架置入。近年来，冠状动脉慢性完全闭塞的逆行入路越来越受欢迎，结果令人鼓舞。即使对于有CABG史的ACS患者，这种新技术也可能提供额外的治疗选择。
