Case5: High take-off vein graft, 60 year old male


This patient underwent coronary artery bypass surgery 6 years ago. Bypass grafts were LITA-LAD and SV-Cx.
Angina recurred recently.
Coronary angiography showed stenosis at the degenerated vein graft.
Anastomosis of the vein graft to aorta was relatively high.


A young operator selected Amplatz L.

6Fr Amplatz L1 engaged the vein graft and angiography was possible to perform.

However, the Amplatz L lost engagement by the guidewire passage. PCI cannot be performed due to weak backup force.

Dr. Ikari suggested to use Ikari L.

6Fr IL4.0 was engaged easily. Backup force was sufficient.

Because of the strong backup force, filter wire was easily inserted and stents were also easily implanted. The guiding catheter was stable.

Final angiography


A high take-off vein graft is sometimes difficult via radial access.
Amplatz L failed to generate backup force. However, Ikari L can generate strong backup force and PCI was successful.
Ikari L is effective for a high-take off vein graft.