PMC2778136_01
(a) Left coronary arteriogram in the right anterior oblique (RAO) projection before coronary intervention. (b) Left coronary arteriogram in the left anterior oblique (LAO) projection five months after surgery.
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A 65-year-old man suffering from ascending aorta aneurism and atherosclerotic three vessel disease without left main coronary (LM) involvement (Figure 1(a)) underwent aortic root replacement with a 27 mm Dacron valve graft conduit. Coronary angiography showed severe LM narrowing (Figure 1(b)) and total ostial occlusion of the saphenous graft to marginal branch.
(a) Left coronary arteriogram in the left anterior oblique (LAO) projection during balloon inflation. (b) Left coronary artery in LAO projection after stenting, demonstrating good angiographic result.
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Then we predilated the LM with a Maverick balloon 3.5 x 20 mm (Boston Scientific, Natick, MA), in order to avoid an expected underexpansion of a stent into the tough, fibrotic lesion due to the inflammatory response to glue (Figure 2(a)). Natick, MA) inflated up to 18 atmospheres for 30 seconds. No technical difficulties occurred, and we obtained a satisfactory final result (Figure 2(b)).