Dados do Trabalho

Título

SAPHENOUS VEIN GRAFT-LEFT ANTERIOR DESCENDING PERCUTANEOUS CORONARY INTERVENTION ASSISTED BY OPTICAL COHERENCE TOMOGRAPHY VIA DISTAL TRANSRADIAL ACCESS.

Introdução

A 50-year-old man, with hypertension, type 2 diabetes, chronic heart failure with reduced ejection fraction and previous (eight years ago) coronary artery bypass grafting (saphenous vein graft to left anterior descending [SVG-LAD] and right internal mammary artery to right coronary artery [RIMA-RCA]), complaining of chest pain at minimal efforts was referred to coronary and surgical grafts angiography. Pervious RIMA-RCA, chronic total occlusions of ostial RCA, mid left circumflex and mid LAD, severe ostial stenosis of a major first diagonal branch, treated by ad hoc percutaneous coronary intervention (PCI), and ostial-proximal de novo SVG-LAD significant lesion were found. 

Material e Método

For this last one, staged PCI with optical coherence tomography (OCT) assis-tance was planned. One week after, the intended procedure was performed, via right distal transradial access (dTRA), our default access site. The target SVG-LAD was engaged with and AL1 guiding catheter and then a distal embolic protection device (FILTERWIRE EZ™, Boston Scientific, Quincy, MA) was carefully placed at its distal portion . Since the Dragonfly™ Optis™ catheter (Abbott, USA) was not able to cross the lesion, even after multiple pre-dilations with a 2.0/20 semi-compliant balloon, two 3.5/26 drug-eluting stents were carefully and optimally deployed at proximal and ostial-proximal SVG-LAD portions, with minimal struts overlapping, and post-dilated with a 3.5/20 non-compliant balloon. OCT pullback confirmed well-expanded, and well-apposed stents, with no edge dissections, fractures or geographic misses; minimal stent area was 6.73 mm2, with adequate full-length stent expansion. 

Resultados

After distal embolic protec-tion device removal, with lots of debris, final TIMI 3 flow was achieved, without the oc-currence of slow-flow or no-reflow at any moment.

Discussão e Conclusões

Adequate hemostasis was unremarkable obtained after two hours with a TR band device. Proximal and distal radial pulses were easily palpable after hemostasis and at hospital discharge, the morning day after, without any minor or major access site-related or clinical complications. Saphenous vein graft lesions requiring mandatory embolic protection devices and also intra-vascular imaging guidance to optimize the PCI can be safely and successfully performed via mini-malist approach (dTRA), with patient comfort and significant reduction of access site-related com-plications.