Severe spasm of the free radial artery graft in a patient undergoing high-risk angioplasty under percutaneous cardiopulmonary support.
This report illustrates a case of percutaneous intervention in a very high-risk patient who already had three previous bypass operations and was not a suitable candidate for further surgical revascularization. Since intra-aortic balloon pump insertion was contraindicated due to the origin of a radial graft from the descending aorta, percutaneous cardiopulmonary support (CPS) was used to perform the procedure. Thus, CPS proved useful in providing adequate hemodynamic support and allowed us to use adequate amount of antispastic drugs to relieve any spasm during the procedure. This case also highlights the need to use antispastic drugs before performing percutaneous interventions on arterial conduits, particularly radial artery grafts which are prone to vasospasm. Since the use of the radial artery for bypass surgery has recently been revived with considerable interest, perhaps more percutaneous interventional procedures may be performed in the future on arterial graft stenosis. We therefore recommend the routine use of vasorelaxant drugs in percutaneous interventions involving arterial grafts.
Ahmed
J M
JM
Cardiac Catheterization Laboratories, Cardiovascular Research Foundation, Washington Hospital Center, 110 Irving Street N.W., Suite 4B1, Washington, D.C. 20010, USA.
Kornowski
R
R
Leon
M B
MB
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000628:therapy; D002315:Cardiopulmonary Bypass / Q000379:methods; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D017534:Radial Artery; D013035:Spasm; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents