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. 2020 Apr;17(4):234-240.
doi: 10.11909/j.issn.1671-5411.2020.04.006.

Percutaneous recanalization of total saphenous vein graft occlusion with excimer laser treatment

Yuan Han  1 , Quan-Min Jing  2 , Qian-Cheng Wang  1 , Yan-Bin Su  2 , Guo-Jun Chen  1
Affiliations

Percutaneous recanalization of total saphenous vein graft occlusion with excimer laser treatment

Yuan Han et al. J Geriatr Cardiol. 2020 Apr.
No abstract available

Keywords: Excimer laser; Percutaneous coronary intervention; Saphenous vein graft.

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Figures

Figure 1.
Figure 1.. Example use of the excimer laser coronary atherectomy in the SVG to the OM branch.
(A): Coronary angiogram showing the total occlusion of the SVG to the OM branch; (B): dye injection revealed a heavy thrombus burden (arrow); (C): the 1.4 mm laser catheter was inserted and the laser ablation was performed (arrow); and (D & E): the final angiogram. OM: obtuse marginal; SVG: saphenous vein graft.
Figure 2.
Figure 2.. The 6-month follow-up angiography of the SVG to the OM branch.
(A): The left anterior oblique 45° view of the SVG to the OM branch angiogram; and (B): the caudal view of the SVG to the OM branch angiogram. OM: obtuse marginal; SVG: saphenous vein graft.
Figure 3.
Figure 3.. Preoperative coronary angiography.
(A): The 90% stenosis with calcification in the proximal segment of the left circumflex artery; (B): the proximal segment of the LAD was total occlusion; (C): the ostial RCA were completely occluded; (D): the SVG to RCA was unobstructed; (E): the SVG to the OM branch was totally occluded (arrow); and (F): the left internal mammary artery to LAD was unobstructed. LAD: left anterior descending; OM: obtuse marginal; RCA: right coronary artery; SVG: saphenous vein graft.
Figure 4.
Figure 4.. The SVG to the OM branch revascularization procedure.
(A): Microcatheter and small balloons failed to cross the left circumflex artery lesion; (B): competitive retrograde blood flow seemed to have developed from the OM branch to the graft anastomosis (arrow); (C & D): the retrograde guidewire passed through the occlusion segment and entered into the ascending aorta; (E): the antegrade guidewire crossed the lesions to the distal OM branch under the direction of the retrograde wire; and (F): angiogram positioned the antegrade guidewire in the true lumen. OM: obtuse marginal; SVG: saphenous vein graft.
Figure 5.
Figure 5.. Example use of the excimer laser coronary atherectomy in the SVG to the OM branch.
(A): Tip injection showed a large amount of thrombus in the middle of SVG (arrow); (B): ablation from the proximal to the distal SVG was performed with the 0.9 mm laser catheter (arrow); (C): two drug-eluting stents (2.75 mm × 36 mm & 3.0 mm × 33 mm) were implanted from the distal to the ostial degenerated SVG; (D): post dilation with the 3.0 mm × 12 mm noncompliant balloon; and (E & F): the final angiogram result after laser facilitated percutaneous coronary intervention. OM: obtuse marginal; SVG: saphenous vein graft.
Figure 6.
Figure 6.. Example use of the excimer laser coronary atherectomy in the SVG to the PDA.
(A–D): The coronary angiogram demonstrate the LIMA to LAD and the SVG to the OM branch were unobstructed, and the SVG to the PDA was occluded; (E): the 1.7 mm laser catheter through the SVG lesions and ablation (arrow); and (F): the good angiographic results after two stents were deployed. LAD: left anterior descending; LIMA: left internal mammary artery; OM: obtuse marginal; PDA: posterior descending artery; SVG: saphenous vein graft.
See this image and copyright information in PMC

References

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