A case of dynamic segmental saphenous vein graft compression during diastole

We present the case of a patient, in whom coronary angiography performed for non-ST-segment elevation myocardial infarction five months after coronary artery bypass graft surgery disclosed a tight stenosis with superimposed diastolic compression in the proximal segment of a saphenous vein graft (SVG) to a diagonal artery. Furthermore, the SVG segment immediately distal to the stenosis exhibited obstructive dynamic compression during diastole. Stent implantation across the proximal stenosis was undertaken successfully with a consequent resolution of the dynamic downstream stenosis. This is the third case of diastolic segmental SVG compression not related to pericardial constriction ever reported in the English literature and the first case where implantation of a balloon-expandable stent was performed in an SVG to treat a significant organic stenosis with superimposed diastolic compression. We discuss the pathophysiologic characteristics of this case and the potential clinical utility of the current stent platforms to adequately scaffold such dynamic lesions.