Key Words Stent polytetrafluoroethylene coronary stent graft Intravascular ultrasound Aneurysm coronary pseudoaneurysm Interventional cardiology

Transcription

1 8 Polytetrafluoroethylene 1 Intravascular Ultrasound Guided Polytetrafluoroethylene Coronary Stent Graft Implantation in a Patient With a Large Coronary Pseudoaneurysm at Eight Months After Coronary Intervention: A Case Report MD Tatsuya Yukio Masashi Hiroyuki Katsuhisa Yasuo Kenji Yoshinori Tomohiro Hiroaki YASUKAWA, MD OZAKI, MD, FJCC KAKIHANA, MD SHINJO, MD WASEDA, MD KURODA, MD ASAI, MD WAKITA, MD KONO, MD TAKASHIMA, Abstract A 67-year-old man with exertional angina presented with a large pseudoaneurysm of the right coronary artery at eight months after balloon angioplasty. Intravascular ultrasound revealed a large saccular pseudoaneurysm of mm diameter at the proximal segment of the right coronary artery. Complete closure of the coronary pseudoaneurysm was successfully obtained using a coronary stent graft consisting of a thin flexible polytetrafluoroethylene PTFE membrane placed between two stents using a unique sandwich technique. Follow-up angiography and intravascular ultrasound revealed no significant restenosis in the PTFE stent graft segment. PTFE coronary stent graft implantation is a feasible, safe and useful method to treat a large coronary pseudoaneurysm after coronary intervention. J Cardiol 2003 Dec ; 42 6 : Key Words Stent polytetrafluoroethylene coronary stent graft Intravascular ultrasound Aneurysm coronary pseudoaneurysm Interventional cardiology percutaneous coronary intervention : PCI 1,2 : Department of Cardiology, Aichi Medical University, Aichi Address for correspondence: YASUKAWA T, MD, Department of Cardiology, Aichi Medical University, Yazako Karimata 21, Nagakute-cho, Aichi-gun, Aichi Manuscript received April 9, 2003; revised June 19, 2003 ; accepted August 21,

2 278 Fig. 1 Coronary angiograms at first coronary intervention Left : Baseline angiogram showing significant stenosis in the proximal and distal segments of the right coronary artery. Right: Successful coronary intervention was performed. intravascular ultrasound : IVUS PCI 3 6 PCI debalking device 7 9 plane old balloon angioplasty : POBA polytetrafluoroethylene PTFE JOSTENT coronary stent graft ; JOMED 67 : : : : % tandem 75% IVUS POBA IVUS 6mm 4.5mm vessel shrinkage 3.5 mm 3.0 mm 10 NHLBI type C IVUS 3.5 mm Multilink stent Guidant NHLBI type B IVUS POBA Fig. 1 : POBA site Fig PTFE 200 mg 200mg 2mg ,000 U J Cardiol 2003 Dec; 42 6 :

3 279 Fig. 2 Coronary angiograms of the stent graft procedure Upper left : The right coronary artery in the proximal segment had a large pseudoaneurysm after the first coronary intervention. Upper right: Coronary angiogram was obtained after direct stenting for the distal lesion. Lower left: Dog bone phenomenon during stent graft balloon inflation. Lower right: Final result after coronary stent graft implantation. 8F JR inch extra support IVUS 3.2F 20MHz Sonicath Ultra ; Cardiovascular Imaging Systems motorized pull back system 0.5 mm/sec mixed plaque mm Fig. 3 7mm IVUS mm Multi-link tristar Guidant 12mm PTFE mm MAXXUM balloon catheter Boston Scientific/Scimed, Inc. bare mount dog bone phenomenon 10

4 280 Fig. 3 Two-dimensional and three-dimensional intravascular ultrasound images before and after stent graft implantation Upper left: Three-dimensional intravascular ultrasound image before stent graft implantation. Upper right: Two-dimensional intravascular ultrasound image of the pseudoaneurysm. Superficial calcification was observed opposite the pseudoaneurysm. Intravascular ultrasound indicates the vessel area was 79.52mm 2, lumen area mm 2, maximum luminal diameter 10.9 mm and minimum luminal diameter 5.7 mm at the pseudoaneurysm. Middle left: Three-dimensional intravascular ultrasound image after stent graft implantation. Middle right : Two-dimensional intravascular ultrasound image of the stent graft. Successful stent graft implantation was performed. Lower: Three-month follow-up intravascular ultrasound images left: three-dimension, right: two-dimension after stent graft implantation. No significant neointimal proliferation is observed in the stent graft. J Cardiol 2003 Dec; 42 6 :

5 IVUS 2.9F 40MHz Atlantis; Cardiovascular Imaging Systems stent graft Figs. 2, 3 : IVUS Multi-link tristar 45% IVUS Multi-link tristar PTFE Fig ,087 Coronary Artery Surgery Study CASS 4.9% 10 PCI Slota 7 Stent Restenosis Study STRESS 334 POBA 7% 3.9% cutting balloon POBA PCI debalking brachytherapy geometric vascular remodeling drug eluting stent incomplete stent apposition 11,12 POBA IVUS 180 POBA. 13 å PCI IVUS IVUSå 2 14 PTFE 1999 Heuser 15 Di Mario Briguori 17 7 PCI 2 Gercken 18 6 PCI PTFE Briguori1 IVUS IVUS PTFE PTFEPTFE 316L 2 dog bone phenomenon PTFE 10 mm Bigger the better concept PCI

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