PMC7457702_01
Coronary angiography during unstable angina demonstrated triple vessel
disease with multiple prior stents and LAD with diffuse disease and severe
stenosis (arrow) which was thought to be the culprit lesion.
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Coronary angiography demonstrated triple vessel disease, with severe LAD stenosis (shown in Figure 1) as well as high grade LCX and RCA lesions.
Carotid angiography prior to CABG showing the right internal carotid artery
with severe stenosis at the ostium (arrow).
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Carotid angiography showed 90% stenosis of the RICA (shown in Figure 2) and 50% stenosis of the left internal carotid artery (LICA).
Coronary angiography after LIMA-LAD coronary artery bypass surgery. There is
a severe kink in the LIMA anastomosis which was inserted proximal to the LAD
lesion (arrow). This resulted in recurrent severe unstable angina.
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Ten days after CABG, the patient again presented with recurrent severe unstable angina and repeat coronary angiogram showed a kink and insertion site stenosis in the LIMA which had been inserted proximal to the LAD lesion (shown in Figure 3).
Coronary angiography after LIMA-LAD coronary artery bypass surgery. This
shows the result after percutaneous coronary intervention of LIMA-LAD. A
drug eluting stent spans the kink and the lesion.
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PCI of the LIMA/LAD was performed with excellent results and complete relief of symptoms (shown in Figure 4).
Treatment of internal carotid stenosis after resolution of angina symptoms
with self-expanding stent placement with cerebral protection device.
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Attention was then shifted to the carotid lesion, and a stent was placed in the RICA with excellent angiographic results (shown in Figure 5).