Abstract
The percutaneous treatment of saphenous vein graft lesions containing angiographically massive thrombus is associated with a high risk of distal embolisation and no-reflow. The optimal management for these lesions remains unclear and a challenge to the interventional cardiologist. Five cases are described in whom the risks of percutaneous angioplasty were felt to be excessive owing to a high thrombus load. Each case was treated with a bolus and infusion of abciximab (ReoPro; Eli Lilly—a platelet glycoprotein IIb/IIIa receptor antagonist) at least 24 hours before further angiography. Repeat angiography of the culprit vein graft, following treatment with abciximab alone, demonstrated a major reduction in the thrombus score and the presence of TIMI 3 flow in each case. Immediately following repeat angiography, angioplasty with stent insertion was performed successfully with no distal embolisation or no-reflow phenomenon. This staged approach, with abciximab used alone to reduce thrombus load, is a new treatment for vein graft lesions containing massive thrombus. Keywords: thrombus; abciximab; glycoprotein IIb/IIIa receptor antagonists; interventional cardiology; angioplasty
Full Text
The Full Text of this article is available as a PDF (116.2 KB).
Figure 1 .
(A) Stenosis in the saphenous vein graft with long filling defect indicating thrombus. (B) Resolution of thrombus following treatment with abciximab.
Figure 2 .
(A) Lobulated filling defect distal to the vein graft stenosis indicating thrombus. (B) Resolution of thrombus following treatment with abciximab.
Figure 3 .
(A) Large filling defect distal to the vein graft stenosis indicating thrombus; TIMI grade 1 flow. (B) Resolution of thrombus and restoration of TIMI 3 flow following treatment with abciximab.