1/282. Spontaneous recanalization of postoperative severe graft stenosis. What is the cause and prognosis of the "string sign" in the internal thoracic artery?A 68-year-old female with unstable angina was treated surgically. She was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with three vessel disease. On a coronary angiogram (CAG), 90% stenoses were found in the left anterior descending coronary artery (LAD), circumflex (CX), and right coronary artery (RCA). She received elective coronary artery bypass grafting (CABG), in which the left internal thoracic artery (LITA) was anastomosed to the LAD and reversed saphenous vein grafts (SVG) were made to segment 12 of the CX, and segment 4PD of the RCA, respectively. The postoperative course was uneventful, but postoperative early graftgraphy revealed distal narrowing of the LITA graft as the so-called "string sign". However, one year post surgery, the LITA string sign was not found and its patency had markedly improved on the second graftgram. It is reported that the LITA "string sign" might cause late graft occlusion. However, this LITA graft evidently enlarged the size and increased the flow of the artery in proportion to myocardial blood demand. To our knowledge, it has not been reported that an in situ LITA string sign on postoperative early graftgram has disappeared in the late phase. We hypothesize that the LITA string sign might be caused by several different factors such as flow competition, spasm, and/or technical problems. In any event, the LITA string sign does not cause graft occlusion in the late postoperative period in every case.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/282. Stenting of a stenotic radial artery coronary graft: a new therapeutic scenario in coronary artery disease.With the increasing application of arterial coronary revascularization, a number of patients may develop arterial graft obstructive disease. In addition, the predominantly muscular structure of the radial artery wall may predispose radial artery coronary grafts to spasm. For the first time, we describe a case of stenting of a stenotic free radial artery graft and discuss the technical and pathophysiological aspects of the procedure.- - - - - - - - - - ranking = 2.5keywords = coronary (Clic here for more details about this article) |
3/282. Pseudoaneurysm following successful excimer laser coronary angioplasty of a restenotic left internal mammary artery graft ostial lesion.Although significant left internal mammary artery graft ostial stenosis is extremely rare, the clinical importance can be profound. In this report we describe a case in which a restenotic left internal mammary artery graft ostial lesion was successfully opened with excimer laser coronary angioplasty. A resulting pseudoaneurysm spontaneously closed after conservative therapy.- - - - - - - - - - ranking = 1.25keywords = coronary (Clic here for more details about this article) |
4/282. Intracoronary stent placement in thrombus containing vein graft lesions.Intracoronary stents are traditionally considered to be contraindicated in presence of thrombus. However recent advances in stent deployment technique have reduced the risk of stent thrombosis. We report the placement of a stent in a thrombus laden saphenous vein graft to the posterior descending artery. Three months later the stent site was patent with severe stenosis with thrombus in another graft which was also stented. Intracoronary stents should be considered in patients with complex lesion even in presence of intraluminal thrombus.- - - - - - - - - - ranking = 1.5keywords = coronary (Clic here for more details about this article) |
5/282. Use of stents to treat kinks causing obstruction in a left internal mammary artery graft.Left internal mammary arteries (LIMA) are used routinely as grafts to the left anterior descending coronary artery (LAD) in selected patients undergoing coronary artery bypass graft (CABG) surgery because of better long-term patency rates. pathology other than fibrointimal hyperplasia, accelerated atherosclerosis, or thrombus can sometimes cause obstructive lesions in such grafts. This report illustrates a kink in a LIMA graft to the LAD causing an obstructive lesion shortly after surgery and describes the subsequent management of this lesion with intracoronary stents.- - - - - - - - - - ranking = 0.75keywords = coronary (Clic here for more details about this article) |
6/282. Immediate vein graft thrombectomy for acute occlusion after coronary artery bypass grafting.A 76-year-old man underwent coronary bypass grafting 3 days after exposure to heparin. Immediately after chest closure, he developed acute graft thrombosis and cardiac arrest in the setting of thrombocytopenia. Immediate graft thrombectomies were performed. Postoperative tests for heparin-induced thrombocytopenia and thrombosis (HITT) were positive. This case represents a dramatic example of HITT after coronary revascularization.- - - - - - - - - - ranking = 1.5keywords = coronary (Clic here for more details about this article) |
7/282. Inadvertent stenting of left main coronary artery complicated by later in-stent restenosis.Stenting of both the protected and unprotected left main coronary artery has been described. This case presents a patient who had inadvertent left main stent deployment. A 47-year-old female presented with a non-Q-wave infarction and subsequent angina leading to angiography and angioplasty of her proximal ramus intermedius artery. Recurrent angina and ECG changes necessitated repeat coronary angiography and angioplasty on the same day with Wiktor stent deployment to treat a resultant dissection. Poststent deployment pictures revealed that the stent had been partially deployed in the left main coronary artery. Additional balloon dilatations were performed at the ostia of the left anterior descending and circumflex arteries through the stent. Three months later the patient presented with progressive angina and was discovered to have severe distal left main stenosis. In a case such as this, stent removal may be preferable to leaving an unnecessary stent within the left main coronary artery. Cathet. Cardiovasc. Intervent. 48:194-197, 1999.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
8/282. A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature.We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.- - - - - - - - - - ranking = 2keywords = coronary (Clic here for more details about this article) |
9/282. Surgical management of arteriosclerotic coronary artery aneurysm.A 60-year-old man suffered antero-septal myocardial infarction at the age of 56. coronary angiography demonstrated total occlusion of the left anterior descending artery and a large saccular aneurysm of the right coronary artery. Diffuse coronary ectasia was also shown in the right coronary artery adjacent to the aneurysm. Despite anticoagulant therapy, the aneurysm formed a thrombus and developed coronary artery stenosis distal to the aneurysm. ligation of the aneurysm and in situ gastroepiploic artery grafting were performed. Sudden heart failure was developed during skin closure. As this condition was considered to be graft hypoperfusion, supplemental saphenous vein grafting was placed. ligation is a simple, reliable technique to prevent future complications for a large saccular right coronary artery aneurysm, however, gastroepiploic artery might be an inappropriate bypass conduit for the ligated coronary artery with diffuse ectasia.- - - - - - - - - - ranking = 2.5keywords = coronary (Clic here for more details about this article) |
10/282. Giant aneurysm of saphenous vein graft to coronary artery compressing the right atrium.aneurysm of reverse aortocoronary saphenous vein graft is a known complication of coronary artery bypass grafting. In this report we present a case of a 60-year-old man who presented 12 years after coronary artery bypass grafting with a giant graft aneurysm of the reverse aortocoronary saphenous vein graft to the right coronary artery, compressing the right atrium. Spiral computed tomography was used to identify the aneurysm measuring 7 x 6 x 7 cm. We also reviewed the English-language literature and found reports of 50 patients with similar aneurysms of which 30 (61%) were identified as true aneurysms and 17 (33%) were identified as pseudoaneurysms. Three patients could not be identified into either group. We reviewed the presenting symptoms, diagnostic tools, and treatment options for this rare entity. An understanding of the pathophysiology of reverse aortocoronary saphenous vein graft aneurysm is important to prevent the possibility of aneurysm rupture, embolization, myocardial infarction, or death.- - - - - - - - - - ranking = 2.5keywords = coronary (Clic here for more details about this article) |
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