Przezskórna angioplastyka Y-pomostu żylnego u pacjenta z niestabilną dławicą piersiową. Czy zwężenie bifurkacji Y-pomostu żylnego jest nadal wyzwaniem?

Abstract

71 years-old patient with history of CABG was admitted to Department of Interventional Cardiology, John Paul II Hospital, Cracow with acute coronary syndrome – unstable angina. The coronary angiography revealed significant narrowing of bifurcated venous bypass graft as the last remaining vessel. After qualification by the Heart Team he underwent percutaneous coronary angioplasty of venous bypass with implantation of self-apposing sirolimus-eluting stent (Stentys). Technical aspects of procedure such as usage of left ventricle assist device, additional imaging (IVUS), type of approach, stent and protection of vessel were considered in this manuscript. Patient with numerous co-morbidities and severely decreased function of left ventricle was rather candidate for percutaneous revascularization. 8 months later patient had implanted implantable cardioverter-defibrillator in primary prevention of sudden cardiac death due to symptomatic chronic heart failure with reduced ejection fraction. Discussion raises the topic of long-term effectiveness of angioplasty in these group of patients. Myocardial revascularization in patient with severe symptoms and diseased last remaining vessel should be obligatory, however multiple comorbidities increases the risk of cardiac surgery as well as percutaneous angioplasty. Critical question is: to treat invasively or with optimal medical treatment?