Reverse Movahed Maneuver: Maximal Expiration Maneuver during Saphenous Vein Graft Intervention for Facilitated Balloon and Stent Delivery in Tortuous Vein Grafts - A Novel Technique.

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.