Balaban Yakup, Elevli Murat Güçlü
Department of Cardiology, Istinye Universty, VM Medicalpark Kocaeli Hospital, Başiskele, Turkey.
Sakarya Özel Adatıp Hastanesi, Kalp-Damar Cerrahisi Kliniği, Sakarya, Turkey.
Clin Med Insights Case Rep. 2019 Jun 6;12:1179547619852621. doi: 10.1177/1179547619852621. eCollection 2019.
We are representing a case of successful retrograde recanalization of a chronic ostial occlusive lesion of the left main coronary artery (LMCA) via a saphenous vein graft. A 70-year-old male patient, with a history of previous (3 years ago) coronary artery bypass surgery, was evaluated with coronary angiography because of his recent anginal symptoms. Left main coronary artery could not be visualized from the aortic root. It could be visualized with drilled balloon technique which was introduced retrogradely from a saphenous vein graft, and the chronic ostial lesion of the LMCA could be treated with balloon dilatation and stenting. Coronary occlusions can be treated retrogradely via the native collaterals and grafts. The coronaries that are not visualized with an antegrade fashion can be visualized with a retrograde way with the drilled balloon introduced through a patent graft. We could not find any publication about this technique on the web-based research. When encountered with a totally occluded ostial lesion of the LMCA, that cannot be visualized even from the aortic root, it may be tried to be visualized through a patent graft retrogradely. This is a safe and reliable method in patients with a total occlusion of the LMCA who also have a patent saphenous vein graft.
我们报告了一例通过大隐静脉移植成功逆行再通左主干冠状动脉（LMCA）慢性开口闭塞病变的病例。一名70岁男性患者，有既往（3年前）冠状动脉搭桥手术史，因近期出现心绞痛症状接受冠状动脉造影评估。从主动脉根部无法看到左主干冠状动脉。通过从大隐静脉移植逆行引入的钻孔球囊技术可以看到它，并且LMCA的慢性开口病变可以通过球囊扩张和支架置入进行治疗。冠状动脉闭塞可以通过天然侧支和移植血管逆行治疗。不能通过顺行方式看到的冠状动脉可以通过经通畅移植血管引入的钻孔球囊以逆行方式看到。在基于网络的研究中，我们未找到关于该技术的任何出版物。当遇到即使从主动脉根部也无法看到的LMCA完全闭塞开口病变时，可以尝试通过通畅的移植血管逆行使其显影。对于LMCA完全闭塞且有通畅大隐静脉移植血管的患者，这是一种安全可靠的方法。
