Key result
Percutaneous coronary intervention of a critical LAD stenosis via a tortuous LIMA jump graft was successfully achieved using a GuideLiner catheter to enable stent delivery.
Why the study?
How should a patient with significant angina and a severe left anterior descending artery stenosis beyond the insertion of a left internal mammary artery jump graft be treated?
Case Report (n=1)
No
How should a patient with significant angina and a severe left anterior descending artery stenosis beyond the insertion of a left internal mammary artery jump graft be treated?
This case demonstrates the feasibility of performing PCI to a mid LAD lesion via a tortuous LIMA jump graft using a left trans-radial approach in a patient with prior CABG and femoral access complications.
Supports feasibility of GuideLiner-assisted PCI in tortuous LIMA grafts; leaves open generalizability and safety in larger cohorts.
BACKGROUND: A 60-year-old man with a history of previous coronary artery bypass grafting (saphenous vein grafting [SVG] to native right coronary artery [RCA] and sequential left internal mammary artery [LIMA] jump grafting to his native first diagonal [D1] and left anterior descending [LAD] arteries), who had developed a previous ischaemic cerebrovascular accident following femoral angiography, re-presented with further ischaemic cardiac symptoms. INVESTIGATIONS: Physical examination, electrocardiography, biochemistry including high-sensitive troponin, echocardiography, and trans-radial angiography. DIAGNOSIS: Severe native 3 vessel disease including ostial occlusion of the LAD, distal left circumflex and obtuse marginal (LCX/OM) disease and proximal RCA occlusion; occluded SVG to RCA, and evidence of a critical stenosis in the mid LAD distal to the insertion of the tortuous LIMA jump graft (diagonal to LAD). TREATMENT: PCI to mid LAD lesion via LIMA jump graft from left trans-radial approach.
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Cockburn et al. (2012) conducted a case report in Severe coronary artery disease with critical LAD stenosis distal to LIMA jump graft (n=1). PCI via LIMA jump graft using GuideLiner catheter was evaluated on Successful stent delivery and revascularization. Percutaneous coronary intervention of a critical LAD stenosis via a tortuous LIMA jump graft was successfully achieved using a GuideLiner catheter to enable stent delivery.
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