Cor Vasa 2014, 56(5):e382-e387 | DOI: 10.1016/j.crvasa.2013.07.008

Percutaneous coronary angioplasty of a bifurcation lesion in the Y saphenous vein graft

Leoš Pleva^a,c,*, Tomáš Jonszta^b, Pavel Kukla^a

^a Kardiovaskulární oddělení, Fakultní nemocnice Ostrava, Ostrava, Česká republika

^b Radiodiagnostický ústav, Fakultní nemocnice Ostrava, Ostrava, Česká republika

^c Lékařská fakulta Ostravské univerzity, Ostrava, Česká republika

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 (4.0/3.5 × 18 mm) and DES PromusElement(4.0 × 20 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 (4.0 × 15 mm) and only a short stent (Liberte 4.0 × 8 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-CTcoronarography.

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 long-term results.

Keywords: Bifurcation; MS-CT coronarography; PCI; Saphenous veingraft

Received: May 14, 2013; Revised: July 22, 2013; Accepted: July 23, 2013; Published: October 1, 2014  Show citation