Vessel rupture and/or perforation represents a serious complication of percutaneous coronary intervention (PCI) of vein grafts. This report presents the case of a 79-year-old man during which PCI of a saphenous vein graft after acute coronary syndrome was complicated by graft perforation successfully treated with implantation of an MGuard stent. The MGuard stent system has a microfibre net anchored to the external surface of the stent, which besides trapping thrombus, might be useful in obtaining the closure of small vessel perforation. Of note, the MGuard stent system does not require prolonged dual-antiplatelet therapy.
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We present the case of a patient with severely stenosed bicuspid aortic valve, admitted with pulmonary oedema and considered for aortic valve replacement with a mechanical prosthesis. Coronary artery disease has been excluded pre-operatively by means of cardiac catheterisation. An anomalous circumflex artery, originating from the right cusp, has been reported. The valve replacement was successful. On day 7 post-operatively, he suffered an episode of sustained ventricular tachycardia associated with raised troponin. A further cardiac catheterisation showed occlusion of the anomalous circumflex artery. Percutaneous coronary intervention has been performed successfully with the placement of four stents. Coronary anomalies are uncommon but this particular anatomy should be regarded during valve replacement.
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Coronary stent fracture is a rare, potentially serious and easily missed complication of coronary artery stenting. An increasing number of stent fractures following mostly Cypher stent implantation have been reported recently. Newer generation DES have been introduced in clinical practice in order to improve technical and clinical characteristics, such as everolimus, zotarolimus and biolimus eluting stents. To our knowledge, this is the first reported case of biolimus Nobori stent complete fracture without, however, clinical sequences. OCT was used for adjunctive imaging and confirmation of the fracture.
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