Treatment of saphenous vein graft thrombosis with distal protection, thrombectomy, and adenosine prior to reperfusion: a complete approach to preserving microvascular integrity.
We report the treatment of an acute myocardial infarction presenting late with thrombotic total occlusion of a saphenous vein graft. A novel approach was used to prevent microvascular obstruction and reperfusion injury, with a distal protection system, a thrombectomy device, and administration of intracoronary adenosine prior to restoration of flow, so that initial reperfusion was done with maximal microvascular vasodilatation.
St  John
Marcus
M
Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
Heldman
Alan W
AW
D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000379:methods*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D017131:Thrombectomy / Q000295:instrumentation; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D000241:Adenosine