Vascular responses to a Viabahn stent graft: evaluation with computed tomographic angiography, angiography, and angiosco
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IMAGES IN CARDIOVASCULAR INTERVENTION
Vascular responses to a Viabahn stent graft: evaluation with computed tomographic angiography, angiography, and angioscopy Yuji Nishimoto1 · Rei Fukuhara1 · Masanao Toma1 · Ryoji Taniguchi1 · Tadashi Miyamoto1 · Yukihito Sato1 Received: 10 October 2018 / Accepted: 10 December 2018 © Japanese Association of Cardiovascular Intervention and Therapeutics 2018
Case
Discussion
A 72-year-old woman with persistent atrial fibrillation underwent an implantation of a heparin-bonded expanded polytetrafluoroethylene (ePTFE)-covered stent (Viabahn, W. L. Gore, Flagstaff, AZ, USA) in her superficial femoral artery (SFA) with severe stenosis including yellow plaques (Fig. 1a, e). The distal reference vessel diameter measured by intravascular ultrasound was 4.5 mm × 5.1 mm. After the implantation of the Viabahn (5 mm × 100 mm), a final angiogram showed it had well-expanded (Fig. 1c). She received uninterrupted antithrombotic therapy with adjusted-dose warfarin and aspirin after the procedure. One year later, duplex ultrasound showed no in-stent restenosis, and a follow-up computed tomographic angiogram showed no in-stent restenosis except at the stent edges, which were unevaluable because of metallic artifact (Fig. 1b). To manage the antithrombotic therapy, follow-up angiography was performed and confirmed there was no in-stent restenosis (Fig. 1d), and angioscopy detected yellow plaques seen through the ePTFE, mural thrombi without neointima coverage (Fig. 1f; Supplement Movie 1), and a small gap between the proximal stent edge and luminal vessel wall (Fig. 1f; Supplement Movie 2), which might have been caused by a weak radial force.
Previous studies reported that Viabahn had better patency than bare-metal stents (BMSs), irrespective of the lesion length [1]. Vascular responses after their implantation have not yet been adequately studied. The main findings of this case were as follows; (1) mural thrombi occurred in the Viabahn stent with heparin-bonded ePTFE under uninterrupted antithrombotic therapy; (2) the ePTFE was transparent, and the folds could not be confirmed; (3) the radial force of the proximal stent edge might have been weak. Ishihara et al. previously reported that drug-eluting stents implanted in the SFA had a higher heterogeneity and thrombus frequency than BMSs [2]. In this case, the Viabahn had mural thrombi, however, there were not so many. This could be mainly because the Viabahn had heparin-bonded ePTFE. The ePTFE folds at the proximal stent edge might cause a malapposition and subsequent edge restenosis [3]. However, current angioscopy could not visualize the ePTFE folds. A higher resolution angioscope or other imaging modalities may be needed.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12928-018-0562-5) contains supplementary material, which is available to authorized users. * Yuji Nishimoto [email protected] 1
Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2‑17‑77 Hi
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