Protected Percutaneous Coronary Intervention (PCI) of Cabrol Type Anastomosis of Saphenous Vein Graft (SVG) to the Left Main Coronary Artery (LMCA)

Abstract

The use of percutaneous left ventricular assist devices (VAD) may minimize the risk of hemodynamic compromise during such high-risk percutaneous coronary intervention (PCI) and allow complete revascularization, thus improving outcomes. A good understanding of cardiac hemodynamics is essential in making informed decisions during such cases. A 61-year-old male with an extensive surgical cardiac history including a modified Cabrol type anastomosis with saphenous vein (SVG) conduits to two coronary arteries presented to our hospital with severe substernal chest discomfort and was noted to have diffuse ST depressions along with subtle ST elevations in lead aVR suggestive of diffuse sub-endocardial ischemia. Diagnostic coronary angiography revealed significant stenosis in the Cabrol type SVG grafts and we opted for a protected PCI using Impella (Abiomed, Danvers, MA) support. A significant drop in the blood pressure was noted and despite trouble-shooting, the Impella arterial line tracing remained minimally pulsatile. A comprehensive understanding of circulatory support physiology was ultimately crucial in making an informed decision for a successful PCI outcome.

Acute Occlusion of a “Protected” Left Main Coronary Artery Manifesting as an Acute Coronary Syndrome with Heart Failure: How much Protected it is?

“…1,3,6 A patient with a complex surgical cardiac history who had undergone CABG using a modified Cabrol type anastomosis with SVG conduits to two coronary arteries suffered recurrent acute coronary syndrome (ACS), as reported by Sabah et al After coronary angiography revealed significant stenosis in the Cabrol-type SVG grafts, they opted for a protected PCI with Impella support. 8 Since LMCA lesions frequently exhibit aorto-ostial involvement and large, calcified, eccentric plaques, the efficacy of routine PTCA is often compromised. This has led to the widespread routine use of cutting-edge interventional devices like stents, atherectomy, and lasers.…”

Case Report: Intravascular Ultrasound-guided Intervention for Anastomosis Stenosis of the Left Main Coronary Artery Post-Cabrol Technique

“…In a PubMed search, we found 11 successful PCI cases of anastomotic stenosis or occlusion between the aortocoronary conduit and the LMCA (3)(4)(5)(11)(12)(13)(14)(15)(16)(17)(18). These results are summarized in Supplementary Table 1.…”