AUCTORES
Globalize your Research
Case Report | DOI: https://doi.org/10.31579/2641-0419/150
1 Interventional cardiologist, Erfan General Hospital, Tehran, Iran
2Weill Cornell Medicine
3 Interventional cardiology fellow, Rajaie Medical Cardiovascular and Research Center, Tehran, Iran
*Corresponding Author: Ehsan Khalilipur, Interventional cardiology fellow, Rajaie Medical Cardiovascular and Research Center, Tehran, Iran
Citation: Arash Hashemi, Ashkan Hashemi, Arsis Ahmadye., Ehsan Khalilipur., (2021) When 7 times angioplasty on Saphenous vein graft would not compete the native vessel percutaneous coronary intervention. J. Clinical Cardiology and Cardiovascular Interventions, 4(7); Doi:10.31579/2641-0419/150
Copyright: © 2021 Ehsan Khalilipur, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 26 February 2021 | Accepted: 24 March 2021 | Published: 02 April 2021
Keywords: coronary intervention; interventional cardiology; coronary artery bypass graft
Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease.
One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.
Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease [1,2]. It has been performed by using saphenous vein graft (SVG) or arterial conduit such as internal mammary or radial arteries [3,4].
The efficacy of coronary artery bypass grafting (CABG) depends on long- term arterial and venous graft patency [5].
One of the most major obstacles after CABGs is atherosclerotic changes of SVG and more than 50 percent of SVG are occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up [3].
SVG failure in these patients is much more troublesome than the deterioration of native coronary artery disease [6]. PCI on native coronary artery is mostly favored to PCI on SVGs because it has been clarified that greater complications are associated with PCI on SVGs [7]. We present a post CABG patient with multiple PCI on SVG attempts and its final PCI on native coronary artery.
The patient is a 68-year-old gentleman known case of diabetes mellitus on oral agent who primarily underwent coronary angiography 8 years ago and was diagnosed with 2 vessel disease with subtotal left anterior descending (LAD) lesion at proximal part and chronic total occlusion (CTO) in dominant left circumflex artery (LCX) at its ostioproximal part and with a diminutive right coronary artery (RCA) which finally heart team decided to perform coronary artery bypass grafting (CABG) that time. Patient was successfully grafted by left internal mammary artery on LAD and saphenous vein graft (SVG) on first optus marginal branch (OM) branch of LCX. Patient was functionally active without any angina for a couple of months but gradually developed angina despite anti-anginal therapy and his cardiologist decided to perform coronary angiography which revealed significant degenerated SVG lesion in its distal part and decided to do percutaneous angioplasty on this SVG with everolimus drug eluting stent (DES) with acceptable final result (figure-1).
Thereafter, patient frequently developed angina and underwent 7 more times of angioplasty and stenting (twice drug eluting balloon on in-stent restenosis, three times of stenting with everolimus eluting DES and once sirolimus eluting DES) on SVG on OM with failed antegrade and retrograde wiring of native CTO of LCX artery for a couple of times. In one of the procedures, interventional cardiologist decided to do the retrograde bifurcational stenting from SVG to the retrograde part of OM which resulted in occluded retrograde part of native Om branch (figure-2).
Patient subsequently complained of low threshold angina even with 3 antianginal drug (beta-blocker, long acting nitrate and ranolazine) and was referred for more evaluation. Transthoracic echocardiography showed moderately reduced left ventricular systolic function with LVEF 35% with hypokinesia in lateral and inferior wall. Besides, we decided to image coronary artery vasculature with invasive coronary angiography which demonstrated patient LIMA on LAD and degenerated SVG and reduced TIMI flow in its proximal to distal pathway. Since resting LV function was reduced we assessed viability in LCX territory with CMR and it was compatible with a viable tissue in hypokinetic segment. At this point of time, because of metallic layers of previous stent struts in SVG and occluded retrograde route, we decided to try antegrade wire esclalation (AWE) in LCX in order to wire the native artery. We primarily tried low tip wire in proximal cap and then with wire escalation and using a microcatheter for more support, wire could successfully reach the distal part of CTO and with escalation of CTO balloons we managed to prepare the diseased part for stent deployment. Two successive everolimus eluting stents (EES) were successfully deployed (figure-3) and 2 months later patient were free of angina with a beta-blocker and had no complaint in his daily activities.
Chronic degenerative processes affect the intervention of aorto-coronary saphenous vein grafts (SVGs) irrespective of the bypassed arterial territory: about 10 percent of SVGs occlude before discharge or within the first 30 days and about 50 percent occlude within 10 years [8,9]. The best predictors of 30-day MACE of SVG intervention are SVG degeneration and plaque volume [10]. In this clinical condition, PCI on native vessel or grafts have been a debate for 2 decades. The use of PCI on a totally occluded SVG with high degeneration may worsen the condition with thrombosis and distal embolization, which can result in no-reflow phenomenon and more myocardial damage [11].
In a recent meta-analysis and systematic review performed by Mohamed Farag et al. PCI on either native coronary or SVGs were compared. Twenty-two studies comprising over forty-thousand patients with median follow-up of 2 years were included. Compared with bypass graft intervention, native artery PCI was more accessible for interventional cardiologists (61% vs. 39%) and was associated with lower major adverse cardiac events (MACE) (P<0.001), and lower target vessel revascularization (TVR) (OR 0.62, 95%CI 0.51-0.76, P<0.001) with no significant difference in the early incidence of major bleeding or stroke. The more TVR risk in bypass graft PCI group was associated with more MACE [12].
In another cohort study conducted by Ahmad Shoaib et al. with the British Cardiovascular Intervention Society (BCIS) database from 2007 to 2014 of patients who underwent SVG-PCI (n = 8619) or CTO-PCI in native arteries (n = 2513) with median age of 68 years in both groups, patients in group 2 were more men, more report of diabetes mellitus, hypertension, dyslipidemia, previous myocardial infarction. Data analysis revealed no significant difference in mortality (odds ratio [OR], 1.70; 95% confidence interval [CI], 0.63-4.58; P=.29), at 30 days or 1 year, no significant difference also was observed for in-hospital MACE rates (OR, 1.36; 95% CI, 0.85-2.19; P=.19). However, more procedural complications and vessel perforation was reported in CTO-PCI. What was remarkable in this cohort was the risk of target-vessel revascularization at 1 year which was similar (SVG-PCI 5.6% vs CTO-PCI 6.9%; P=.08) [13].
Because of the more anatomical complexity of the native vessels and the longer duration of coronary artery disease, antegrade approach of CTO in patients with prior CABG is more sophisticated [14]. As we depicted in our patient, retrograde pathway was unintentionally inaccessible because of previous procedures and the only route to alleviate the ischemia was antegrade approach. We could precisely escalate wires in order to cross distal part of the CTO with a microcatheter support and finally LCX artery was revascularized by deploying EES with acceptable result in spite of inability to wire OM branch which had a degenerated SVG.
As it is remarkable in recent studies, it is still a debate to decide whether to intervene on native CTO or SVG’s. As we have shown in this case report, native vessel intervention is prerferred approach however, heart-team approach would be as a lighthouse to guide for a better decision making in these patients.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
