title: A unique stenosis in saphenous vein graft visualized by optical coherence tomography.
abstract: We present a case of a unique stenosis in a 12-year-old saphenous vein graft (SVG), to the right coronary artery, which was visualized by optical coherence tomography (OCT), before percutaneous coronary intervention. The patient was an 80-year-old man in whom the stenosis was documented by area-detector coronary computed tomography. OCT imaging demonstrated that the culprit lesion was a venous valve containing a thrombus before preintervention imaging. Coronary stenting was performed with a distal protection device, and pathologic examination of the aspirate verified the OCT findings. Coronary angiography 12 years previously, just after coronary artery bypass surgery (CABG), had shown a completely normal SVG without any suspicion of a venous valve. These OCT images suggested the possibility that the culprit lesion was an "upside down" venous valve that was not visualized by angiography just after surgery, but could be a cause of late SVG stenosis following CABG. OCT imaging is very useful for clarifying the etiology of the stenosis in cases of ambiguous angiographic lesions.
authors.affiliation: Division of Cardiology, Department of Internal Medicine and Memorial Heart Center, Iwate Medical University School of Medicine, 1-2-1 Chuo-dori, Morioka, Iwate, 020-8505, Japan, ori-aka@hotmail.co.jp.
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Koeda
authors.forename: Tomonori
authors.initials: T
authors.lastname: Itoh
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Fusazaki
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Morino
mesh_terms: D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011237:Predictive Value of Tests; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000473:pathology* / Q000637:transplantation*; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome