title: Primary PCI in a patient with acute occlusion of native LAD beyond the LIMA graft anastomosis: first reported case, technical challenges and review of the literature.
abstract: We present a case of a man with an anterior STEMI due to acute occlusion of the LAD, distally to the anastomosis with LIMA graft. We describe our treatment strategy with primary PCI and the difficulties we encountered: insufficient length of balloon and stent shafts and need for deep intubation of the graft with the guiding catheter. The procedure was complicated by graft dissection that was successfully treated with a DES. Afterwards we successfully stented the culprit lesion. We discuss technical possibilities for overcoming such difficulties and present brief review of literature on STEMI in patients with previous CABG.
authors.affiliation: Heart and Vessels Department, Careggi Hospital, Largo Brambilla 3, 50144, Florence, Italy, meuccif@aou-careggi.toscana.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Meucci
authors.forename: Miroslava
authors.initials: M
authors.lastname: Stolcova
authors.forename: Paolo
authors.initials: P
authors.lastname: Valoti
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003327:Coronary Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012086:Reoperation; D015607:Stents