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