Muhammad Usman Shah, Muhammad Anis Haider, Krishna Poudyal, Mahmoud Loubani, Syed Yaseen Naqvi
{"title":"Drug-eluting balloon to treat immediate post-coronary artery bypass grafting (CABG) ST-elevation myocardial infarction (STEMI) - A case report","authors":"Muhammad Usman Shah, Muhammad Anis Haider, Krishna Poudyal, Mahmoud Loubani, Syed Yaseen Naqvi","doi":"10.1093/ehjcr/ytae245","DOIUrl":null,"url":null,"abstract":"\n \n \n Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents.\n \n \n \n A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications.\n \n \n \n Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset ST-elevation myocardial infarction (STEMI). Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.\n","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal - Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjcr/ytae245","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents.
A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications.
Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset ST-elevation myocardial infarction (STEMI). Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.
冠状动脉旁路移植(CABG)手术是一项重大的心血管手术,可能会因移植失败而导致术后ST段抬高型心肌梗死(STEMI)。由于植入的移植物在经皮使用药物洗脱支架治疗时容易出现并发症,因此诊断和治疗具有挑战性。 一名 60 多岁的男子接受了心血管造影术,术后虽然静脉注射了鸦片制剂,但前导联出现了新的持续 2 毫米 ST 波抬高,且无明显胸痛。经胸超声心动图无法确诊。紧急进行的有创血管造影显示,左前降支中动脉与左乳内动脉(LIMA)移植物吻合处出现血栓闭塞。通过移植物进行干预被认为并发症风险很高,因此使用了原生冠状动脉来接近闭塞处,并先后使用了半顺应性球囊和药物洗脱球囊进行了联合球囊血管成形术,成功清除了闭塞。随着 ST 波抬高的缓解,LIMA 开始恢复工作,并且没有立即出现并发症。 术后早期连续导联的 ST 波抬高不容忽视,因为这往往是新发 ST 波抬高型心肌梗死(STEMI)的唯一特征。与药物洗脱支架相比,药物洗脱球囊是治疗这些病症的可行且可能更安全的选择。