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Coronary Revascularization Following Failed Multiple Percutaneous Coronary Intravascular Stents
Bharath V, Milind Hote;
AIIMS, New Delhi, India
BACKGROUND – Multiple blocked Percutaneous Coronary Intervention (PCI) stents pose a significant challenge while planning Coronary Artery Bypass Grafting (CABG). In most cases, a suitable target site for distal graft anastomosis is difficult to obtain.
METHODS – In this technically challenging case report, we discuss a case of 40-year aged male presenting with recurrent angina due to blocked multiple PCI stents in Left Anterior Descending (LAD) vessel. He underwent CABG in which due to non-availability of suitable target site in LAD, the previous stents in LAD had to be excised along with intima and bypass grafting performed by implanting long segment vein patch over the endarterectomized LAD and Left Internal Mammary Artery (LIMA) anastomosed over the vein patch.
RESULTS – Post-operative course was uneventful. Patient was extuabated on post-operative day (POD) 1
and shifted out of Intensive Care Unit (ICU) on POD3. He was discharged in stable condition on POD 5.
CONCLUSIONS – In cases where CABG needs to be performed following multiple failed PCI stents, option of stent excision along with CABG is a safe option with good short term results.
Legend Image 1 – Stent being removed from LAD along with vessel intimaImage 2 - Vein patch being sutured over LAD
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