Key result
A staged approach using abciximab at least 24 hours before angioplasty successfully reduced thrombus load and achieved TIMI 3 flow without distal embolisation in 5 cases.
Why the study?
Does a staged approach with abciximab followed by delayed stent implantation improve angiographic outcomes and prevent no-reflow in patients with saphenous vein graft lesions containing massive thrombus?
Case Report (n=5)
Does a staged approach with abciximab followed by delayed stent implantation improve angiographic outcomes and prevent no-reflow in patients with saphenous vein graft lesions containing massive thrombus?
A staged approach using abciximab infusion prior to stenting effectively reduces thrombus burden and prevents no-reflow in high-risk saphenous vein graft lesions.
Hypothesis-generating for staged abciximab in thrombotic SVG lesions; prospective trials needed before adoption.
The percutaneous treatment of saphenous vein graft lesions containing angiographically massive thrombus is associated with a high risk of distal embolisation and no-reflow. The optimal management for these lesions remains unclear and a challenge to the interventional cardiologist. Five cases are described in whom the risks of percutaneous angioplasty were felt to be excessive owing to a high thrombus load. Each case was treated with a bolus and infusion of abciximab (ReoPro; Eli Lilly-a platelet glycoprotein IIb/IIIa receptor antagonist) at least 24 hours before further angiography. Repeat angiography of the culprit vein graft, following treatment with abciximab alone, demonstrated a major reduction in the thrombus score and the presence of TIMI 3 flow in each case. Immediately following repeat angiography, angioplasty with stent insertion was performed successfully with no distal embolisation or no-reflow phenomenon. This staged approach, with abciximab used alone to reduce thrombus load, is a new treatment for vein graft lesions containing massive thrombus.
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Nm et al. (1999) conducted a case report in Saphenous vein graft lesions containing massive thrombus (n=5). Abciximab followed by delayed stent implantation was evaluated on Reduction in thrombus score and presence of TIMI 3 flow. A staged approach using abciximab at least 24 hours before angioplasty successfully reduced thrombus load and achieved TIMI 3 flow without distal embolisation in 5 cases.
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