“TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock

Abstract

Introduction. Bifurcation lesions on venous Y grafts are rare. We presented a case of a woman who developed NSTEMI complicated by cardiogenic shock due to a bifurcation lesion on the venous Y graft for LAD and RCX. Case outline. A 72-year-old woman was admitted to the CCU as an emergency in September 2017 due to the acute heart failure followed by the development of cardiogenic shock. Urgent coronarography revealed severe atherosclerotic disease of native coronary arteries with significant bifurcation lesion on venous Y graft for LAD and RCX (medina classification of 1,1,1) with TIMI 2 flow. According to the general condition of patient, a life-saving ad hoc PCI was performed. Two stents were implanted in Y graft with T and protrusion technique achieving optimal result followed with patient stabilization. On one-year follow-up patient was without symptoms of angina, and CT coronarography revealed patent both stents in Y graft. Best to our knowledge this was the first described TAP technique used on Y graft. Conclusion. The PCI on VG is not uncommon either in elective cases or in cases with ACS due to the poorer persistence and more frequent progression of atherosclerotic disease in the venous grafts. The use of bifurcation techniques for the treatment of lesions on VG and especially on the Y graft is rare, but it can be used the same way it is used in native vessels.