Successful Treatment of a Huge Thrombotic Saphenous Vein Graft Occlusion With Aspiration Thrombectomy: A Case Report

Abstract

Saphenous vein grafts (SVGs) are widely used conduits for the surgical revascularization of coronary arteries, but they are associated with poor long-term patency rates. Acute SVG thromboses often present as acute coronary syndrome and have an extensive atherosclerotic and thrombotic burden. Percutaneous coronary intervention (PCI) is the first treatment option; however, it carries a high risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Reducing the thrombus burden and preventing distal embolization during PCI can be achieved by using some pharmacological strategies (e.g., glycoprotein IIb/IIIa antagonists) and devices (e.g., thrombectomy and filter devices). There are yet no better therapeutic options for patients undergoing PCI of SVG occlusions. Here, we introduce a 52-year-old male patient admitted with a typical acute chest pain of 1 hour’s duration. Electrocardiography showed signs of acute inferoposterior myocardial infarction. A thrombotic SVG occlusion was detected in primary PCI, and a huge thrombus content was aspirated. After the thrombus aspiration with stent implantation, the chest pain was relieved and the ST-segment elevation was improved. The patient has been followed without any symptoms for 10 months. © 2020, Tehran Heart Center. All rights reserved.