title: Distal occluder and rheolytic thrombectomy of a saphenous vein graft lesion with a large associated thrombus.
abstract: Percutaneous intervention in thrombus-containing lesions is frequently associated with complications, including distal embolization and no-reflow. In saphenous vein bypass grafts (SVG), friable atheroma and associated thrombus make interventions particularly difficult. Distal protection strategies are in development, but complete protection with removal of all potentially embolic material is challenging. This case illustrates a novel technique using a distal occluder balloon and rheolytic thrombectomy followed by stent deployment to treat a SVG lesion. This combination therapy was technically feasible, resulted in no angiographic complications and normal creatine kinase levels throughout follow-up, and can be used during high risk SVG interventions.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. aheldman@jhmi.edu
authors.forename: Alan W
authors.initials: AW
authors.lastname: Heldman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D020878:Device Removal; D005260:Female; D006801:Humans; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D012501:Saphenous Vein / Q000473:pathology* / Q000637:transplantation*; D015607:Stents; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex