“TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock (original) (raw)
Related papers
Percutaneous coronary angioplasty of a bifurcation lesion in the Y saphenous vein graft
2013
Background: The use of Y-shaped aorto-coronary saphenous vein grafts is most commonly driven by efforts to replace the poor quality (length) of the vein grafts or to minimise manipulation of the atheromatous ascending aorta (Jarvis [1]). We found only a few case reports describing PCI of bifurcation lesions in vein grafts in the available scientific literature (Karalis [2], Prosser and Bailey [3], Chan et al. [4]). Method: We present two case reports of patients with bifurcation lesions in Y saphenous vein grafts. In case No. 1, implantation of a dedicated bifurcation stent Tryton (4.0/ 3.5Â18 mm) and DES Promus Element (4.0Â20 mm) was used to treat the Y-graft bifurcation lesion. In case No. 2, due to satisfying result of side branch stenosis predilation, the bifurcation lesion was treated by a drug-eluting balloon catheter SeQuent Please (4.0Â15 mm) and only a short stent (Liberte 4.0Â8 mm) was implanted in the proximal residual stenosis of the main branch. Results: In both cases satisfying periprocedural angiographic results with final TIMI flow 3 were achieved. During the 12-month follow-up no MACE (CV death, AMI, TVR) has been recorded and both patients were without residual angina pectoris. Persistent satisfying angiographic results were confirmed on MS-CT coronarography. Conclusion: PCI of the bifurcation lesions in the vein grafts is a rare but complicated condition. In our two case reports we demonstrated that the use of a dedicated bifurcation Tryton Side Branch Stent, as well as the SeQuent Please paclitaxel coated balloon catheter for PCI of the bifurcation lesions in Y vein grafts, is technically feasible with satisfactory longterm results.
The "crush" technique as a therapeutic approach for a bifurcation lesion in a saphenous venous graft
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Bifurcation lesions of native coronary arteries are common in daily practice and different strategies for percutaneous coronary intervention have been suggested for their treatment. The "crush" technique, with the use of drug-eluting stents in both the main and the side branch, is a relatively simple procedure that ensures complete lesion coverage, even for bifurcations that have extensive disease within the side branch. We present the case of a bifurcation lesion in a Y-shaped saphenous venous graft in a patient who had previously undergone coronary artery bypass graft surgery. The literature lacks reports regarding the management of such patients. Implementation of the "crush" technique in the specific case resulted in a satisfactory angiographic and long-term clinical outcome.
The Annals of thoracic …, 2004
plications, and was discharged home on postoperative day 9. The patient is currently angina-free 16 months postoperatively and has no restrictions on her level of activity. Comment The feasibility of perfusing myocardium through coronary veins was first suggested by Pratt in 1898 [1]. The concept was particularly appealing given that the coronary venous system does not develop severe arteriosclerosis. Beck and colleagues proposed a global attempt at retrograde coronary venous perfusion in 1948, well before the advent of coronary artery bypass grafting (CABG). The Beck II procedure consisted of a free vein graft from the aorta to the coronary sinus, with a second operation 2 to 3 weeks later to ligate the coronary sinus [2]. Initially, arterial blood perfusing the coronary sinus was shown to be reaching the capillary bed. However, with a high mortality rate (approximately 30%) and evidence of early graft thrombosis [3], clinical acceptance did not follow. With the advent of CABG in the late 1960s, interest in venous retroperfusion quickly receeded. However, CABG was soon discovered to have its own limitations, particularly in patients with diffuse atherosclerotic disease and small coronary arteries. Arterialization of coronary veins therefore regained its appeal. Several investigators in the 1970s examined the technique of selective arterialization of the coronary venous system to reverse venous flow in precise areas of ischemia. Such procedures entailed the construction of a coronary venous bypass graft (CVBG) with ligation of the vein cephalad to the anastomosis, thus avoiding an arterio-venous fistula through the coronary sinus. Results from animal studies were contradictory [4]. Some researchers reported reversal of ischemia, improved myocardial perfusion, and improved LV contraction post-CVBG. Hochberg, one of the major contributors to the field, demonstrated that CVBG to an acutely ischemic LV could improve blood flow by almost three times, with all layers of myocardium receiving increased blood flow [5]. In addition, long-term studies in dogs revealed patency of 10 of 14 grafts 5 months postoperatively. Other investigators, however, reported that CVBG caused striking myocardial hemorrhage and congestion, and resulted in distal vein fibrosis and luminal stenosis within a few weeks. The efficacy of selective coronary vein arterialization has yet to be adequately studied in humans. The few case series that exist in the literature consist of small groups of patients who had selective venous bypass operations in conjunction with CABG. The effectiveness of the technique is therefore difficult to interpret. A 1986 survey of American cardiac surgeons reported 41 cases of CVBG being performed because conventional CABG was thought to be unsuitable [6]. Eighty-eight percent of patients improved symptomatically, 92% survived longterm, and 12 of 13 grafts studied by postoperative coronary angiography were found to be patent. Clearly, the number of CVBGs performed in humans is too small to draw meaningful conclusions regarding the utility of this procedure. We are encouraged however, by this patient's postoperative outcome, although interpretation is complicated by the addition of an LAD graft. Unfortunately, no postoperative image studies were obtained to document improved myocardial perfusion. Other revascularization techniques such as trans-myocardial revascularization (TMR) may also have been effective, but are not available at our hospital. Nevertheless, we believe the technique of CVBG may be an innovative and effective approach in difficult cases of surgical revascularization and deserves further exploration.
Cardiology and Angiology: An International Journal
Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI. Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were exc...
Cardiovascular revascularization medicine : including molecular interventions, 2018
The contribution of different left main (LM) bifurcation stenting techniques on long-term CV mortality has been poorly investigated. We evaluated the 3-year outcomes of revascularization of unprotected complex bifurcation LM in patients with cardiogenic shock (CS) with LM bifurcation/distal disease as culprit lesion. We analyzed 752 consecutive patients with STEMI admitted to our centre from 1 January 2014 to 1 March 2018, searching for patients with CS and complex distal/bifurcation LM disease as culprit lesion who received, at operators' discretion, LM double stenting by means of Culotte, T-stenting/TAP or Nano-crush technique. Fifty-seven patients (23 females, mean age 62.3 ± 10.5 years) with CS and STEMI with distal/bifurcation LM as culprit lesion were identified: 20 patients (35.0%) received Culotte, 16 patients (28.0%) received T-stenting/TAP and 20 (35.0%) received Nano-crush technique. At 3-year follow-up, clinical-driven target lesion revascularization, and mortality r...
The Annals of Thoracic Surgery, 2005
Methods. In 53 of 60 consecutive patients who underwent complete myocardial revascularization using only this composite arterial graft, good transthoracic echocardiographic images and pulsed Doppler signals of the Y-graft main stem were obtained at rest and early after standard exercise. Stress/rest 99mTc-sestamibi myocardial perfusion singlephoton emission computed tomography (SPECT) was the gold standard for residual myocardial ischemia. The patients with negative SPECT were divided into groups according to the number of coronary artery systems grafted, and history of preoperative myocardial infarction.
Journal of Cardiac Surgery, 2004
Objectives: The aim of this study was to evaluate the early postoperative outcome in patients undergoing "ω-anastomosis" construction, a technique that permits revascularization of coronary bifurcations employing a single arterial graft. Materials and methods: Between January 2000 and March 2002, ω-anastomosis was employed in 12 patients. The main indication for ω-anastomosis construction was the presence of a significant stenotic lesion involving one of the coronary tree's bifurcations, presenting a relevant secondary branch. There were ten men and two women, with a mean age of 55.4 ± 4.3 years (range 48 to 66). The ω-anastomosis was constructed employing a single arterial graft (internal mammary artery or radial artery) effectively tailored to obtain a bi-petal shape and anastomosed to the coronary bifurcation according to a three-foliate anastomosis. All patients underwent postoperative coronary angiography. Results: There were no hospital deaths, neither ECG nor enzymatic alterations. One patient was reoperated for excessive bleeding. The mean aortic cross-clamp time and duration of CPB (cardiopulmonary bypass) were 64 ± 18 minutes (range 45 to 108) and 89 ± 26 minutes (range 67 to 135), respectively. Thirty-four arterial conduits were used: 12 LIMA, 12 RIMA, and 10 RA. Twelve ω-anastomoses were constructed, in six patients employing the RA, and in six other patients employing one of the internal mammary arteries (IMAs). Five left Y-grafts between the in situ LIMA and free LIMA graft and one right Y-graft between the RIMA and RA were constructed. The mean ICU stay was 14.4 ± 5.7 hours. The postoperative coronary angiography revealed a good patency of the "ω-anastomosis." Transthoracic color Doppler echocardiography (TTECD) demonstrated a normal IMAs flow pattern in all cases. Conclusions: We define the reported configuration as a possible surgical alternative to achieve total arterial myocardial revascularization in multi-vessels patients, associated with excellent postoperative outcome that should be part of the coronary surgical armamentar-
Exclusive Y graft operation for multivessel coronary revascularization
The Annals of Thoracic Surgery, 1999
Background. The pedicled (in-situ) left internal mammary artery grafted to the left anterior descending artery has a very high late patency and reduces late mortality following coronary artery bypass surgery. A technique is described which achieves total arterial revascularization in patients with multivessel coronary disease and which is also entirely pedicled.
2021
Coronary bifurcation remains a unique region of the coronary tree. The specific anatomy and blood flow determine the complex mechanisms of atherosclerotic plaque location. The treatment strategy should be chosen with caution as the failure of percutaneous coronary interventions (PCI) may expose a significantly larger area of the myocardium to ischemia than in the case of single vessel PCI. In order to understand the complexity of the clinical situation in patients after the treatment of coronary bifurcation, and the constantly evolving techniques of the procedure itself, this review presents basic information on the anatomy and classification, up-to-date step-by-step analysis of the optimal technique for PCI, beginning with qualification, planning and preparation for the procedure, through stent selection and ending with optimization techniques. Different PCI strategies are presented and explained, the indications for onevs. two-stent techniques are evaluated, the available and reco...