Intra-arterial administration of 10 mg recombinant tissue plasminogen activator (rt-PA) combined with percutaneous coronary intervention successfully resolved a subtotally occluded venous bypass graft thrombus.
Case Report (n=1)
No
In a patient with NSTEMI due to a subtotally occluded venous bypass graft, a multifaceted interventional approach including local thrombolysis with rt-PA successfully restored coronary flow and resolved the thrombus.
Coronary artery bypass grafting (CABG) is a common and effective treatment for patients with complex coronary artery disease. This case report discusses a 75-year-old male patient who presented with angina and shortness of breath due to thrombus formation in a venous graft 20 years after CABG. Initial diagnostics indicated non-ST-elevation myocardial infarction, leading to immediate intervention. Cardiac catheterization revealed thrombus in the vein graft to the large first diagonal branch, necessitating percutaneous coronary intervention. Despite initial efforts, thrombus aspiration and further catheter advancement were unsuccessful. A combination of balloon angioplasty, stent implantation, and intra-arterial thrombolysis with recombinant tissue plasminogen activator (rt-PA) was employed, resulting in significant thrombus reduction and improved coronary flow. Follow-up coronary CT angiography (CCTA) confirmed complete thrombus resolution and patent graft. The patient was discharged with dual antiplatelet therapy and showed favorable outcomes. This case emphasizes the challenges of managing thrombotic complications in venous bypass grafts and highlights the effectiveness of a multifaceted interventional approach combined with CCTA for non-invasive patient follow-up and assessment of treatment success. Furthermore, a review of the current literature on the role of local thrombolysis for occluded coronary artery bypass grafts is provided.
Renker et al. (Mon,) conducted a case report in Acute coronary syndrome (NSTEMI) with subtotally occluded venous bypass graft (n=1). Percutaneous coronary intervention with intra-arterial recombinant tissue plasminogen activator (rt-PA) was evaluated on Thrombus resolution and graft patency. Intra-arterial administration of 10 mg recombinant tissue plasminogen activator (rt-PA) combined with percutaneous coronary intervention successfully resolved a subtotally occluded venous bypass graft thrombus.