Total occlusion of a Cypher™ stent in a gastroepiploic artery coronary bypass graft: A case report

A 54-year-old male was admitted for heart failure. Coronary angiography revealed three vessel disease with total occlusion of the RCA and LAD. He underwent bypass grafting with GEA to RCA and LITA to LAD. Angiography after the operation demonstrated focal 90% stenosis in the GEA. A 3.0 mm × 18 mm Cypher™ stent was successfully implanted in the GEA. During the procedure vigorous spasm developed recurrently. Follow-up angiography at 6 months demonstrated insidious occlusion of the GEA graft at the stent site despite aggressive antiplatelet therapy. Prolonged mechanical stimulation of the GEA by a metal strut without the endotheliarization of a drug eluting stent might have initiated vigorous spasm and contributed to the stent occlusion in this case.