Successful treatment of saphenous venous graft thrombus by tirofiban infusion

This is a case of an interventional dilemma about how to manage a large thrombus, located distally from and adherent to a severe stenosis in a coronary venous bypass graft, with a TIMI-3 flow in a patient with a non-ST-elevation myocardial infarction. This case report concerns a 70-year-old female patient, diagnosed with unstable angina, 18 asymptomatic years after coronary bypass surgery. Although a high risk of a severe ischaemic event is present, immediate coronary intervention is not mandatory since perfusion is maintained, and given the real risk of embolisation of the large thrombus, even contra-indicated. From this perspective, the option to bail out and install an extensive antithrombotic therapy prior to delayed intervention is reasonable.

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Successful Treatment of a Huge Thrombotic Saphenous Vein Graft Occlusion with Aspiration Thrombectomy: A Case Report

Akçay

2020

JTHC

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Saphenous vein grafts (SVGs) are widely used conduits for the surgical revascularization of coronary arteries, but they are associated with poor long-term patency rates. Acute SVG thromboses often present as acute coronary syndrome and have an extensive atherosclerotic and thrombotic burden. Percutaneous coronary intervention (PCI) is the first treatment option; however, it carries a high risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Reducing the thrombus burden and preventing distal embolization during PCI can be achieved by using some pharmacological strategies (e.g., glycoprotein IIb/IIIa antagonists) and devices (e.g., thrombectomy and filter devices). There are yet no better therapeutic options for patients undergoing PCI of SVG occlusions. Here, we introduce a 52-year-old male patient admitted with a typical acute chest pain of 1 hour’s duration. Electrocardiography showed signs of acute inferoposterior myocardial infarction. A thrombotic SVG occlusion was detected in primary PCI, and a huge thrombus content was aspirated. After the thrombus aspiration with stent implantation, the chest pain was relieved and the ST-segment elevation was improved. The patient has been followed without any symptoms for 10 months.

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Successful treatment of saphenous venous graft thrombus by tirofiban infusion

Cited by 4 publications

References 19 publications

“DVT” of the Heart

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Successful Treatment of a Huge Thrombotic Saphenous Vein Graft Occlusion with Aspiration Thrombectomy: A Case Report

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