Multimodality imaging evaluation of saphenous vein graft peri-stent contrast staining enlargement

  • PDF / 582,975 Bytes
  • 2 Pages / 595.276 x 790.866 pts Page_size
  • 34 Downloads / 154 Views

DOWNLOAD

REPORT


IMAGES IN CV APPLICATIONS

Multimodality imaging evaluation of saphenous vein graft peri-stent contrast staining enlargement Naoki Shibata1,2   · Tsuyoshi Sugiura1 · Akihito Tanaka2 · Kiyokazu Shimizu1 Received: 3 July 2020 / Accepted: 10 July 2020 © Springer Nature B.V. 2020

Abstract A patient with Takayasu arteritis who underwent CABG using a saphenous vein graft (SVG) experienced ventricular fibrillation due to total SVG occlusion. A drug-eluting stent was implanted; however, follow-up CAG demonstrated an advanced expansion of peri-stent contrast staining. Coronary computed tomography angiography revealed contrast media extending around the SVG. An intravascular ultrasound indicated a worsening stent malapposition and a significant positive remodeling. Keywords  Peri-stent contrast staining · Saphenous vein graft · Multimodality imaging A 47-year-old woman who underwent Bentall and hemiarch replacement due to severe aortic regurgitation was diagnosed with Takayasu arteritis and started on steroid therapy. After two years, she experienced exertional angina; coronary computed tomography angiography (CCTA) indicated a pseudoaneurysm of the left coronary button. An excision and aortocoronary bypass grafting with saphenous vein graft (SVG) to the left main trunk were performed. Within 2 months, she was readmitted to the hospital due to ventricular fibrillation. Emergency coronary angiography (CAG) revealed total SVG occlusion due to a massive organized thrombus; thus, an everolimus-eluting stent was implanted (Panel A1; Fig. 1). Final imaging via intravascular ultrasound (IVUS) showed sufficient stent expansion (Panel A2; Fig. 1), and CCTA at discharge showed good patency of SVG (Panels A3,4; Fig. 1). After 2 years, however, follow-up CAG demonstrated a peri-stent contrast staining (PSS) (Panel B1; Fig. 1), and IVUS indicating a dashed line revealed a stent malapposition (white arrow) and positive remodeling of SVG (white arrowhead) (Panel

B2; Fig. 1). CCTA indicated the contrast media extending around the stent (Panels B3,4; Fig. 1). Furthermore, 4-year follow-up CAG indicated an advanced PSS expansion (Panel C1; Fig. 1); IVUS and CCTA showed a worsening stent malapposition (yellow arrow) and an enlargement of SVG aneurysm (yellow arrowhead) (Panels C2-4; Fig. 1). Studies have reported that PSS is associated with late stent malapposition and positive remodeling [1] causing a high shear-flow disturbance and subsequent target lesion failure [2]. PSS is considered an abnormal coronary artery wall response to the antiproliferative drug released from drug-eluting stent. In this case, we observed PSS enlargement in SVG using multimodality imaging.

* Naoki Shibata [email protected] 1



Ichinomiya Municipal Hospital, Ichinomiya, Japan



Nagoya University Graduate School of Medicine, Nagoya, Japan

2

13

Vol.:(0123456789)



The International Journal of Cardiovascular Imaging

Fig. 1  Follow-up imagings of the saphenous vein graft peri-stent contrast staining

Compliance with ethical standards  Conflict of int