5/25/2023 0 Comments French guidelinerIVL is not approved in the ICA territory and not approved for treating underexpanded or recoiled old or new stents. ICA endovascular intervention is unique due to high risk of stroke and distal protection is mandatory to qualify for procedure re-imbursement. IVL has only rarely been tried in ICA territory. We report use of Intravascular Lithotripsy (IVL) in the internal carotid artery (ICA). Additionally, the severely calcified lesions are more likely to undergo recoil after successful balloon expansion and even after stenting leading to stent recoil. Severe arterial calcification can make balloon and stent expansion challenging. The authors would like to acknowledge Thomas Dolan and Matthew Hazzard, medical illustrators at the University of Kentucky for helping with the illustration for this paper. That the work has not been published nor is under consideration for publication elsewhere other than in oral, poster or abstract format, and that appropriate attribution and citation is given That the corresponding author has the approval of all other listed authors for the submission and publication of all versions of the manuscript, that all authors have made a significant independent contribution and that no one who justifies being an author has been omitted from authorship. We successfully performed percutaneous intervention for a stenotic Cabrol graft-left main coronary artery anastomosis with favorable outcome. Intended to be an improvement on the Bentall technique, the modified Cabrol technique is not without its inherent limitations including graft kinking/thrombosis, Conclusion Our patient was considered a suboptimal surgical candidate due to his history of multiple chest surgeries and the patient's preference to pursue a non-invasive approach. We report a case of successful percutaneous coronary intervention through a Cabrol graft in a patient with anginal symptoms and extrinsic ostial LMCA stenosis. A 6-month post-surgical chest computed Discussion The patient had a bicuspid aortic valve with severe aortic regurgitation and ascending aortic aneurysm status-post Bentall procedure with aortic valve replacement with On-X 25 mm valve and aortic root reconstruction with a 28 mm Dacron tube graft with coronary reimplantation 2 years prior. As interventionalists are increasingly involved in percutaneous management of surgical grafts and bypasses, an anatomical understanding to approach postsurgical aortic composite graft-coronary lesions percutaneously is essential.Ī 30-years-old man presented to our emergency department with exertional chest pain radiating to his back and left arm for two weeks associated with shortness of breath. First reported in 2005, percutaneous intervention of occlusion of the Cabrol graft and of stenosis of the graft-coronary anastomosis is gaining popularity due to its minimally invasive nature in patients with multiple previous surgeries. Although the modified Cabrol technique can be used to reimplant the left or right coronary artery, tension on the left coronary anastomosis is more common, and isolated grafting to this side may be sufficient. The interposed graft relieves tension at the coronary-aorta anastomosis and is useful when the coronary ostia are low-lying or when scarring from previous surgery limits coronary mobilization. In the modified Cabrol technique, the Dacron graft is anastomosed end-to-side to the aortic graft and end-to-end to the native coronary artery. First described in 1981, the Cabrol technique interposes an 8–10 mm diameter Dacron graft between the aortic root and the coronary artery. However, tension and tugging at the site of the coronary-aorta anastomosis may lead to post-operative leak or pseudoaneurysm. The Bentall procedure involves the direct reimplantation of the coronary arteries into the aortic graft prosthesis. Reimplantation of the coronary arteries after surgical aortic root replacement requires different techniques.
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