"Backdoor" alternative approach to stenting of a post-anastomotic coronary artery lesion via a chronically obstructed right coronary artery after failure to stent through a tortuous free internal mammary graft.
We describe the case of a patient who previously had coronary artery bypass grafting including a free right internal mammary artery graft anastomosed to a chronic totally occluded right coronary artery (RCA) proximally and distally and who presented with a high-risk acute coronary syndrome. Coronary angiography revealed the graft to be patent with a distal post-anastomotic culprit lesion within the posterolateral branch of the native RCA. Because of technical challenges, PCI could not be performed through the graft and the lesion was stented via the chronically occluded RCA instead, in a "backdoor" approach with a good final result.
Department of Cardiology, Gosford Hospital, Holden Street, Gosford, New South Wales, Australia.
Richard Y J
RY
Chan
Brendan
B
Gunalingam
D017023:Coronary Angiography; D003326:Coronary Circulation; D003331:Coronary Vessels; D003937:Diagnosis, Differential; D006083:Graft Occlusion, Vascular / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008875:Middle Aged; D015607:Stents