Dynamic nutcracker-like compression of saphenous vein graft by adjacent stents

Systolic compression of coronary flow is a rare angiographic finding and usually results from intramyocardial bridging. In this article, the first reported case of iatrogenic dynamic saphenous vein graft compression by adjacent stents is presented. The cyclic movements of the stents resemble the action of a nutcracker with the involved segment at the fulcrum. Previous angiography 4 months prior showed no evidence of such flow impairment, thereby excluding intramyocardial bridging as a potential etiology. Progressive scarring and fibrosis may result in adhesion of a noncoronary conduit to a stationary mediastinal structure. Thus, conceptually, such vessels would be more prone to systolic compression and torsion, as they do not move with the cardiac cycle. Although the stent deployment may be beneficial in some scenarios, complications of vessel rupture and stent collapse can occur. The pathophysiology, natural history, and treatment of dynamic vessel compression are briefly reviewed.