Kim Tae-Hoon, Marfatia Ravi, Lee Juyong, Azrin Michael
University of Connecticut Health Center, Farmington, CT, USA.
Oconee Heart and Vascular Center, Saint Mary's Hospital, Athens, GA, USA.
Cardiovasc Revasc Med. 2017 Sep;18(6S1):56-59. doi: 10.1016/j.carrev.2017.03.019. Epub 2017 Mar 23.
A 68year old female patient underwent coronary artery bypass surgery (CABG) 1year previously. At that time she had a giant coronary artery aneurysm (CAA) of the proximal right coronary artery and severe 3 vessel disease including a severe ostial right coronary artery stenosis, severe stenosis of the proximal and mid left anterior descending artery (LAD) and a totally occluded left circumflex artery. She underwent CABG including left internal mammary artery to LAD, aorto-saphenous venous graft (ASVG) to posterior descending artery and ASVG sequential to the first diagonal and obtuse marginal branch. Subsequent computed tomography and invasive angiography demonstrated increasing size of the aneurysm (from 42 by 37mm to 50 by 42mm) which was now fed retrograde via the graft to the posterior descending artery in addition to being fed antegrade by the native vessel through a high grade stenosis. Percutaneous covered stent insertion was planned. The aneurysm was traversed with a guide wire, but passage of Viabahn covered stents was difficult due to the 8 Fr guide catheter and the bulky and rigid structure of the Viabahn stent. Using a distal anchoring technique and dual guide catheters, successful passage of two Viabahn stents (two of 5 by 50mm) was accomplished. The technique utilized is described.
一名68岁女性患者1年前接受了冠状动脉搭桥手术（CABG）。当时，她患有右冠状动脉近端巨大冠状动脉瘤（CAA）以及严重的三支血管病变，包括严重的右冠状动脉开口狭窄、左前降支近端和中段严重狭窄以及左旋支完全闭塞。她接受了CABG，包括左乳内动脉至左前降支、主动脉-大隐静脉移植血管（ASVG）至后降支以及ASVG依次连接至第一对角支和钝缘支。随后的计算机断层扫描和有创血管造影显示动脉瘤大小增加（从42×37mm增至50×42mm），现在除了通过自身血管经高度狭窄处顺行供血外，还通过移植血管逆行供血至后降支。计划进行经皮覆膜支架置入术。用导丝穿过动脉瘤，但由于8F引导导管以及Viabahn覆膜支架体积大且结构坚硬，Viabahn覆膜支架难以通过。采用远端锚定技术和双引导导管，成功置入了两枚Viabahn支架（两枚5×50mm）。描述了所采用的技术。
