Author + information
- Received February 17, 2015
- Accepted February 26, 2015
- Published online July 1, 2015.
- Satoru Mitomo, MD∗,
- Toru Naganuma, MD∗,
- Koji Hozawa, MD∗,
- Kensuke Takagi, MD∗,
- Tatsuya Nakao, MD, PhD† and
- Sunao Nakamura, MD, PhD∗∗ ()
- ∗Department of Cardiology, New Tokyo Hospital, Chiba, Japan
- †Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
- ↵∗Reprint requests and correspondence:
Dr. Sunao Nakamura, Department of Cardiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan.
A 59-year-old woman with severe mitral regurgitation underwent mitral annuloplasty (MAP) with a 28-mm Carpentier-Edwards Physio II annuloplasty ring (Edwards Lifesciences, Irvine, California). On post-operative day 10, the patient complained of chest oppression with ischemic changes on an electrocardiogram during rehabilitation therapy. Coronary angiography (CAG) showed severe focal stenosis in the middle of the left circumflex artery (LCx) that had not been detected by preoperative CAG (Figures 1A to 1C). Pre-procedural optical coherence tomography (OCT) showed severe narrowing (lumen area: 0.8 mm2), with no evidence of hematoma, plaque, or thrombi. The vessel was compressed from the outside (Figure 2A), with normal vessel structure of the 3 layers at the site of the culprit lesion. In addition, intravascular ultrasound (IVUS) showed that the vessel was bent with some force from the epicardial side (Figure 2B). These intravascular images suggested that this new focal stenosis may have been caused by accidental ligation of the LCx during MAP.
Considering the high risk of repeat open surgery, the heart team opted for percutaneous revascularization. Pre-dilation was performed gently with a 2.5-mm noncompliant balloon, followed by implantation of a 3.0 × 18-mm Driver stent (Medtronic CardioVascular, Santa Rosa, California) (Figure 1D). Post-procedural OCT and IVUS showed good stent expansion and apposition (minimal stent area: 6.1 mm2), with no evidence of coronary injury (Figures 2C to 2E). At 5-year follow-up, CAG with aspirin alone (Figure 1E), OCT, IVUS, and multidetector computed tomography showed no evidence of significant stent recoil (minimal stent area: 5.6 mm2) (Figures 2F to 2H). Furthermore, the echocardiogram showed no recurrent mitral regurgitation at that time.
To the best of our knowledge, there are no reports regarding long-term follow-up after stenting for iatrogenic coronary stenosis (1). Our case suggests that bailout stenting with a bare metal stent for iatrogenic coronary stenosis may be associated with favorable long-term outcomes.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 17, 2015.
- Accepted February 26, 2015.
- American College of Cardiology Foundation