PMC9883707_01
Operative image of on-pump coronary artery bypass graft surgery. Showing attachment of saphenous venous graft on left anterior descending artery and a 6 Fr radial sheath inserted and stitched in the saphenous venous graft. Sheath stops within the saphenous venous graft without entering the left anterior descending.
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This sheath SVG combination was then used for contrast injections and for taking wire and balloons into distal LAD (Figure 1).
Coronary angiogram done in modified left anterior oblique cranial view. Contrast injection through radial sheath inserted in saphenous venous graft stitched over left anterior descending arteriotomy. Shows diffusely diseased mid-to-distal left anterior descending artery.
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Gentle contrast injections were taken through the SVG sheath (Figure 2) and then segment of LAD, distal to arteriotomy site, to be treated with angioplasty was marked by placing two metal clips on top of the heart surface.
Balloon angioplasty. (A) Angiographic still image showing the area of interest marked with two metallic clips placed over the heart surface and predilatation with 1.5 and 2 mm balloons. (B) Angiographic still image showing balloon angioplasty with 2 mm drug-coated balloon inflation.
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Mid-to-distal LAD disease was predilated between the 2 metal clips with 1.5 and 2 mm semi-compliant, Sprinter (Medtronic) balloons (Figure 3A). Braun), extending 5 mm on both sides of predilated LAD segment (Figure 3B).
Post-procedure angiography. (A) Final result after drug-coated balloon angioplasty by contrast injection from radial sheath/saphenous vein graft through left anterior descending arteriotomy. (B) Angiographic still image of contrast injection through left internal mammary artery graft immediately post procedure via right femoral access.
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Excellent angiographic result was obtained with no residual stenosis (Figure 4A). LIMA injection was done to confirm patency of LAD distal to LIMA insertion, that showed excellent results and CABG completed (Figure 4B).
Six-month follow-up computerized tomography scan graft study showing patent mid-to-distal left anterior descending which was treated with drug-coated balloon, and a well-functioning left internal mammary artery graft.
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CT coronary angiography at 6 months revealed a patent LIMA to LAD with no significant stenosis in mid-to-distal LAD (Figure 5).