Drug-eluting balloon to treat immediate post-coronary artery bypass grafting ST-elevation myocardial infarction: a case report

TL;DR

A drug-eluting balloon successfully treated a rare heart attack complication after bypass surgery, avoiding risks associated with traditional stents.

Contribution

Demonstrates drug-eluting balloon as a novel, safer treatment for post-CABG STEMI when graft intervention is risky.

Findings

Drug-eluting balloon successfully cleared a thrombotic occlusion in a post-CABG STEMI case.

Use of native coronary arteries allowed intervention without graft complications.

ST elevation resolved with no immediate complications following balloon angioplasty.

Abstract

Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents.

A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications.

Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset STEMI. Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.

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