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Direct stenting of vein graft and use of Guard-wire
Interventional cardiologist Dr. Luigi Piatti
Center Ospedale "A.Manzoni", Lecco, Italy
History Male, 60 y.o. – In 1995 coronary by-pass LIMA-LAD + sequential venous graft Aorta-Diagonal-Diagonal-Maginal-RPD. Now unstable angina.

Native vessels: occlusive three vessels disease.

By-passes: LIMA-LAD patent, with no significant stenosis; sequential venous graft AO-Diag.-Diag.-Marg.-RPA patent with critical ostial stenosis, with floating thrombus (fig.1).
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Fig.1.

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Fig. 2.

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Fig.3.
Strategy Two days of intravenous infusion of Tirofiban and Heparin (in the meanwhile start Clopidogrel) ; afterwards direct stent, with distal protection device.
Procedure Right radial approach (small hematoma at right groin).

Guiding catheter Medtronic Zuma 2 MB1 7F.

Positioning of a wire Medtronic/AVE GuardWire Plus; inflation of the distal protection balloon the achieve the occlusion of the venous graft; deployment of a stent BX Velocity 4.5 mm.18 (fig.2). Aspiration of embolic debris with the aspiration catheter.

Good final angiographic result (fig. 3), normal flow (TIMI 3). Uneventful clinical course.

Comments Even though the use of the Medtronic/AVE GuardWire Plus protection device is recommended with 8F catheters, a large lumen 7F catheter is big enough and makes the transradial use of this device possible in most cases.