A patient with prior coronary artery bypass graft surgery presented with NSTEMI. Coronary angiography showed a degenerated SVG to the diagonal with TIMI 2 flow that appeared to be the culprit lesion. We delivered a Filterwire but this caused no reflow with ST segment elevation and chest pain, likely due to distal embolization. Administration of intracoronary nicardipine, eptifibatide and epinephrine restored antegrade flow. Dual injection was performed showing a diagonal CTO with an ambiguous proximal cap. Another attempt for PCI of the SVG-diagonal was done using a Spider embolic protection device, but no reflow happened again and could not be reversed despite intragraft vasodilator administration.
Негізгі бет Case 158: Manual of PCI: The degenerated SVG
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