Implantation of a peripheral bare metal stent for a very late stenosis of a left aortic main Cabrol graft: about a case

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Eur Heart J Case Rep. 2022 Feb 26;6(3):ytac096. doi: 10.1093/ehjcr/ytac096. March 2022 eCollection.

ABSTRACT

Background: Surgical repair of the ascending aorta using the Cabrol procedure involves the interposition of a prosthetic conduit between the aortic prosthesis and the native coronary ostia. Previous cases of Cabrol duct stenosis have been described, most of which presented as acute coronary syndromes due to thrombotic graft occlusion.

CASE SUMMARY: We present a case of stable exertional angina due to very late coronary prosthetic conduit stenosis successfully treated with percutaneous transfemoral angioplasty and off-label implantation of a balloon-expandable bare metal stent designed for peripheral arterial disease. The multimodality imaging approach has made an essential contribution to both lesion assessment and procedure planning. Despite concerns about long-term outcomes, a bare metal peripheral stent was preferred over a standard drug-eluting coronary stent due to the remarkable size of the Cabrol conduit. Three years after the procedure, the patient is free of angina and the coronary CT scan showed no significant luminal loss from the stent.

CONCLUSION: Elective angioplasty of a Cabrol graft requires careful planning through multimodal stenosis assessment. Conventional coronary stents may not be large enough to provide adequate apposition to the large prosthetic conduit and peripheral bare metal stents may be considered, at the cost of unknown long-term results.

PMID:35474684 | PMC: PMC9026236 | DOI: 10.1093/ehjcr/ytac096

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