Javed Asim, Siddiqueh Musfireh, Anjum Qudsia, Jalal Anjum
Head of Cardiology Department/Director Cath Lab, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan.
Eur Heart J Case Rep. 2023 Jan 11;7(1):ytad014. doi: 10.1093/ehjcr/ytad014. eCollection 2023 Jan.
Patients undergoing coronary artery bypass graft (CABG) sometimes have critical proximal lesion in left anterior descending (LAD) artery or chronic total occlusion followed by either skip lesions or diffuse disease of late mid-to-distal LAD artery. Such lesions require endarterectomy or atheroma bridging via long venous or arterial patch (patch-plasty), for which clinical outcomes are conflicting in studies due to a more thrombogenic milieu created by patch-plasty as well as incomplete endarterectomy. We present a hybrid approach with drug-coated balloon (DCB) angioplasty of mid-to-distal LAD through LAD arteriotomy followed by left internal mammary artery (LIMA) insertion to LAD.
A 35-year-old man who was thrombolyzed for anterior wall myocardial infarction in another city, reported to our hospital four weeks later with persistent angina. Coronary angiography showed severe multivessel coronary artery disease. There was diffuse disease in LAD distal to potential site of LIMA insertion and needed patch-plasty. We carried out a hybrid procedure by performing DCB angioplasty of mid-to-distal LAD through the LAD arteriotomy site during CABG followed by LIMA insertion to the LAD. The patient remained asymptomatic post procedure with a 6-month follow-up computerized tomography scan showing patent LIMA and mid-to-distal LAD.
This case shows a novel technique, first in the world, of performing angioplasty during CABG through arteriotomy followed by graft insertion.
接受冠状动脉旁路移植术（CABG）的患者有时在左前降支（LAD）动脉有严重的近端病变或慢性完全闭塞，随后出现跳跃病变或LAD动脉中远端弥漫性疾病。此类病变需要进行动脉内膜切除术或通过长静脉或动脉补片（补片成形术）进行动脉粥样硬化搭桥，由于补片成形术造成的血栓形成环境以及不完全的动脉内膜切除术，在研究中临床结果存在矛盾。我们提出一种混合方法，即通过LAD动脉切开术对LAD中远端进行药物涂层球囊（DCB）血管成形术，随后将左乳内动脉（LIMA）插入LAD。
一名35岁男性在另一个城市接受了前壁心肌梗死溶栓治疗，四周后因持续心绞痛到我院就诊。冠状动脉造影显示严重的多支冠状动脉疾病。在LIMA插入的潜在部位远端的LAD存在弥漫性疾病，需要进行补片成形术。我们在CABG期间通过LAD动脉切开部位对LAD中远端进行DCB血管成形术，随后将LIMA插入LAD，实施了一种混合手术。术后患者无症状，6个月的随访计算机断层扫描显示LIMA和LAD中远端通畅。
本病例展示了一种世界首创的新技术，即在CABG期间通过动脉切开术进行血管成形术，随后进行移植物植入。
