Percutaneous coronary intervention involving tortuous saphenous vein grafts can be
difficult during balloon or stent advancement. There are many available techniques
to facilitate stent delivery in tortuous vessel, such as using specialized catheter
body wires, use of extra support wires or using extra back up guide catheters. All
these techniques have limitations and can be costly and time-consuming. We previously
published a maneuver that showed how to facilitate stent delivery in tortuous native
coronary arteries by instructing the patient to take a deep breath leading to straightening
of the coronary tree, thereby, substantially improving stent deliverability. However,
this maneuver will cause worsening of tortuosity in a proximal segment of a vein graft
during vein graft interventions as the aorta will be pulled downward during inspiration
leading to increasing kink in the vein graft. Hereby, the so called reverse “Movahed
Maneuver” during vein graft interventions is described. It is the exact opposite maneuver
of deep inspiration previously described for native coronary interventions. By letting
the patient perform complete expiration, the body of the intervening saphenous vein
graft will be straightened as the aorta and aortic arch will be moved upward in the
chest leading to facilitated stent deliverability. This maneuver has been performed
successfully in many cases of difficult vein graft interventions due to tortuosity.
This maneuver is easy to perform and can save substantial time as well as radiation
in many challenging vein graft interventions and has not been described previously.
Keywords
percutaneous coronary intervention - expiration - stent delivery - angioplasty - stent
- stenting - coronary artery disease - PCI - saphenous vein graft intervention - SVG
- tortuosity
