Stent graft implantation in spontaneously recanalized LIMA graft after redo coronary bypass operation

The authors present the case of a male patient who sustained posterobasal myocardial infarction and one year later for three vessel disease a coronary bypass operation with three anastomoses (including LIMA-LAD and vein grafts) was performed. After 13 years repeat coronary angiography showed patent LIMA graft besides occluded vein grafts and native coronary vessels. Since attempt for recanalization of a venous graft was unsuccessful subsequent redo bypass surgery was performed substituting the occluded grafts with a sequential vein. On the fourth postoperative day chest pain and ST changes on the ECG developed and the acute re-catheterization showed the occlusion of the LIMA-LAD bypass while the vein graft was patent therefore RIMA was anastomosed to LAD without ECC urgently in the operating room. Two years later subsequent coronary angiogram due to reoccurrence of angina symptoms proved recanalization of the LIMA graft with significant stenosis at the site of the occlusion. RIMA-LAD bypass was patent showing only unsatisfactory filling to the distal part of the LAD. For this reason a 3/26 mm Jostent GraftMaster stent graft was implanted into the recanalized but stenosed part of the LIMA bypass with excellent angiographic result. After 6 months of the intervention the patient was free of angina at the follow up. To the best of our knowledge, this is the first reported case of spontaneous recanalization of an occluded internal mammary graft.