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Ultrafast computed tomographic scanning to assess patency of coronary artery stents in bypass grafts
M A Nyman1, R S Schwartz, J F Breen
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, MN 55905.
Insights
Chest pain after coronary stent placement in bypass grafts can indicate occlusion. Ultrafast computed tomography offers a noninvasive method to assess stent patency in patients on anticoagulation, avoiding risks of coronary angiography.
Area of Science:
- Cardiovascular medicine
- Medical imaging
- Interventional cardiology
Background:
- Coronary artery bypass grafting (CABG) with stent implantation is a common procedure.
- Post-operative chest pain following stenting in bypass grafts raises concerns about potential stent occlusion.
- Conventional diagnostic methods like coronary angiography are invasive and contraindicated in patients on anticoagulation therapy (e.g., warfarin sodium with a therapeutic international normalized ratio).
Observation:
- A case study involving a patient experiencing anginal chest pain after receiving a metallic stent in a vein graft.
- The patient was on warfarin sodium therapy, necessitating a noninvasive diagnostic approach.
- Ultrafast computed tomography (UFCT) was employed to evaluate the patency of the stent in the vein graft.
Findings:
- Ultrafast computed tomography successfully demonstrated the patency of the metallic stent within the vein graft.
- The noninvasive imaging technique provided definitive evidence of blood flow through the stented segment.
- This finding was crucial in diagnosing the cause of chest pain and reassuring the patient and clinicians.
Implications:
- Ultrafast computed tomography presents a promising, minimally invasive alternative for assessing stent patency in challenging clinical scenarios.
- This technique may be particularly valuable for patients with chest pain who have undergone stenting in bypass grafts and are on anticoagulation.
- Clinical application of UFCT could improve diagnostic accuracy and patient management, reducing the need for invasive procedures.
Abstract:
Anginal chest pain after implantation of coronary stents in bypass grafts is a concern because it suggests the possibility of occlusion. Coronary angiography is the definitive method for determining patency of a stent; however, this procedure is relatively contraindicated in a patient receiving warfarin sodium, who has a therapeutic international normalized ratio. An alternative method for determining patency of a stent is by ultrafast computed tomography. This new, minimally invasive technique shows promise for determining blood flow within the large vessels of the thorax. Herein we describe a case in which a metallic stent placed in a vein graft was noninvasively established to be patent, despite chest pain in the patient. This method may be clinically applicable for determining patency of stents in vein grafts in the setting of patients with chest pain who have undergone complete anticoagulation.