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Case Reports
. 2021 Aug 16;25(2):110-114.
doi: 10.1016/j.jccase.2021.07.007. eCollection 2022 Feb.

A case of a coronary covered stent for repeated restenosis at the anastomosis site between saphenous vein graft and graft prosthesis

Masaomi Gohbara  1 , Teruyasu Sugano  1 , Toshiyuki Ishikawa  1 , Kouichi Tamura  1 , Kazuo Kimura  1   2
Affiliations
Case Reports

A case of a coronary covered stent for repeated restenosis at the anastomosis site between saphenous vein graft and graft prosthesis

Masaomi Gohbara et al. J Cardiol Cases. .

Abstract

A 56-year-old man was admitted with a diagnosis of non-ST-segment elevation myocardial infarction, after surgery for total arch replacement, aortic root replacement with a mechanical aortic valve, and coronary artery reconstruction by the Piehler method for acute aortic dissection. Coronary angiography (CAG) revealed a 99% stenosis of the anastomosis site between the J Graft (Japan Lifeline, Tokyo, Japan) and the saphenous vein graft (SVG), which was distally sutured to his right coronary artery (posterior descending artery). After percutaneous coronary intervention (PCI) with a drug-eluting stent to the anastomosis site, repeated in-stent restenosis unfortunately occurred. Despite repeated PCIs, he was again admitted due to exertional angina pectoris, with proven inferior myocardial ischemia by stress myocardial perfusion imaging. We therefore decided to use a coronary covered stent for the anastomosis site to seal neointimal proliferation. GRAFTMASTER 2.8/19 mm (Abbott, CA, USA) was implanted in the anastomosis site, and a follow-up CAG one-year later revealed that the covered stent was clearly opened. To the best of our knowledge, this is the first paper to demonstrate the usefulness of a covered stent for repeated restenosis of the anastomosis site between SVG and graft prostheses. <Learning objective: A coronary covered stent is a stent with a membrane designed to seal the rupture site in cases with a coronary rupture. However, coronary covered stent implantation is an optional method in cases with repeated restenosis of the anastomosis site between the saphenous vein graft and graft prosthesis.>.

Keywords: Covered stent; Graft prosthesis; Restenosis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Coronary computed-tomography angiography at 1st non-ST-segment elevation myocardial infarction. Saphenous vein graft (SVG) was used as a bypass graft from J Graft 9 mm to his posterior descending artery of the right coronary artery, and the distal end of J Graft 9 mm was sutured to his left main trunk (LMT).
Fig. 2
Fig. 2
Angiography and optical frequency domain imaging at chronic phase. (a) The hinge motion of the stent distal site was observed before a covered stent implantation. (b) A covered stent was implanted to cover the anastomosis site, resulting in three stents partially overlapping. The hinge motion was improved. (c) One-year follow-up coronary angiography revealed that the covered stent remained clearly open. (d) Optical frequency domain imaging 7 months later clearly revealed good apposition of the covered stent with less neointimal coverage than the distal stent. LAO, left anterior oblique.
Fig. 3
Fig. 3
Intravascular ultrasound (IVUS) imaging during the percutaneous coronary intervention IVUS revealed excessive in-stent neointimal proliferation composed of iso-echoic lesion with some calcification (Calc) or low-echoic lesion. SVG, saphenous vein graft.
See this image and copyright information in PMC

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