PCI after CABG PCI after CABG PCI after CABG PCI after CABG Wen Wen‐Yi Yi Guo Guo, Haichang Haichang Wang, Wang, Weijie Weijie Li, Li, Yanhong Yanhong Fan Fan Department of Cardiology, Department of Cardiology, Xijing Xijing Hospital Hospital Xi’an China Xi’an China
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PCI after CABGPCI after CABGPCI after CABGPCI after CABG
•• AMI and AMI and angioangio showed triple vessel showed triple vessel di d CABG d 8di d CABG d 8disease and CABG was done 8 years agodisease and CABG was done 8 years ago
•• Risk factors: Hypertension andRisk factors: Hypertension andRisk factors: Hypertension and Risk factors: Hypertension and hyperlipidemiahyperlipidemia
bl fbl f•• Diagnosis: unstable angina pectoris after Diagnosis: unstable angina pectoris after CABGCABG
ECGECGECGECG
OMI(anterior wall) and STOMI(anterior wall) and ST‐‐T depressionT depression( )( ) pp
Other dataOther dataOther dataOther data
•• CKCK‐‐MB and MB and cTnIcTnI: normal: normal
UCG OMI ( t i ll) EF 54%UCG OMI ( t i ll) EF 54%•• UCG: OMI (anterior wall) EF: 54%UCG: OMI (anterior wall) EF: 54%
2 752 75××2929 SSES d l d i OMES d l d i OM 3 03 0××2929 SES deployedSES deployed inin LMLM LCXLCX2.752.75××29 29 SSES deployed in OMES deployed in OM 3.03.0××2929 SES deployed SES deployed in in LMLM‐‐LCXLCX
Final resultsFinal resultsFinal resultsFinal results
ThenThenThen…Then…•• AsymtomaticAsymtomatic ‐‐Maybe no need to touch RCA?Maybe no need to touch RCA?AsymtomaticAsymtomatic Maybe no need to touch RCA?Maybe no need to touch RCA?
•• Went back home after 3 daysWent back home after 3 days
•• RT medical therapyRT medical therapy
•• ExertionalExertional angina after 18 monthsangina after 18 months
•• Administration and reAdministration and re‐‐angiograghyangiograghy
•• Everything isEverything is almost samealmost same with the resultwith the result•• Everything is Everything is almost same almost same with the result with the result after 1after 1stst stentingstenting
ECGECGECGECG
Then we decided to open SVGThen we decided to open SVG‐‐PDA of RCAPDA of RCAThen we decided to open SVGThen we decided to open SVG PDA of RCAPDA of RCA
d d ld d lStentingStenting and post dilatationand post dilatation
4.04.0××20mm20mm DES DES deployed deployed ininThe The stent couldn’t fully stent couldn’t fully openedopened afterafter 30atm30atm NCNC00 00 SS dep oyeddep oyed
SVGSVG‐‐RCARCAopened opened after after 30atm30atm NC NC balloon dilatation…balloon dilatation…
•• Administration after 7days (Transfer fromAdministration after 7days (Transfer fromAdministration after 7days (Transfer from Administration after 7days (Transfer from other hospital)other hospital)
i li l b lib li ii d id i ii f lf l ii ii•• DistalDistal embolicembolic protectionprotection devicedevice isis usefuluseful inin veinveingraftgraft PCIPCI