title: Successful deployment of polytetrafluoroethylene-covered stent to seal left internal mammary artery graft perforation due to guide catheter extension system.
abstract: Coronary artery bypass graft perforation during percutaneous coronary intervention is a rare complication. Perforation of a left internal mammary artery (LIMA) graft due to a guide catheter extension system has not been described. We report the successful deployment of a polytetrafluoroethylene (PTFE)-covered stent to seal the LIMA graft perforation due to the guide catheter extension system. Percutaneous coronary intervention was performed for a culprit lesion of the distal left circumflex via the LIMA graft. A balloon catheter failed to be delivered because the LIMA graft was very long and tortuous. The guide catheter extension system was introduced, and the balloon was delivered and inflated. However, the LIMA graft perforation with continuous extravasation was caused by the edge of deeper intubated guide extension catheter when a coronary stent was attempted to be delivered to the culprit lesion. A long balloon inflation was performed, but the perforation was not completely sealed. The PTFE-covered stent was successfully deployed and sealed the LIMA graft perforation. This case describes that the rapid deployment of PTFE-covered stent is effective to treat severe coronary artery bypass graft perforation due to the guide catheter extension system.
authors.affiliation: Department of Invasive Cardiology, Englewood Hospital and Medical Center, Englewood, New Jersey. Electronic address: e.ichimoto@nifty.com.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ichimoto
authors.affiliation: Department of Invasive Cardiology, Englewood Hospital and Medical Center, Englewood, New Jersey.
authors.forename: Joseph
authors.initials: J
authors.lastname: De Gregorio
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D062906:Cardiac Catheters; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D019233:Retreatment; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
chemical_list: D011138:Polytetrafluoroethylene
keywords: Coronary artery bypass graft perforation; Covered stent; Guide catheter extension system