JACC Case Rep. 2026 Sep 23:110416. doi: 10.1016/j.jaccas.2026.110416. Online ahead of print.
ABSTRACT
BACKGROUND: Saphenous vein graft (SVG) pseudoaneurysms are rare late complications of coronary artery bypass grafting associated with rupture and embolization.
CASE SUMMARY: A 64-year-old woman presented with progressive dyspnea and chest pain 16 years after coronary artery bypass grafting. Computed tomography demonstrated a large-necked pseudoaneurysm of the proximal SVG. Given her high surgical risk and anatomy unsuitable for coverage with a single covered stent, intravascular ultrasound-guided percutaneous exclusion was performed using a novel dual-stent scaffolding technique. A long drug-eluting stent provided structural support for subsequent covered stent deployment, successfully excluding the pseudoaneurysm with TIMI flow grade 3.
DISCUSSION: Complex SVG pseudoaneurysms with large necks may challenge conventional covered stent strategies. Dual-stent scaffolding provides a stable landing zone and structural support for percutaneous exclusion.
TAKE-HOME MESSAGE: Intravascular ultrasound-guided dual-stent scaffolding may offer a feasible strategy for complex SVG pseudoaneurysms in high-risk surgical patients.
PMID:42776118 | DOI:10.1016/j.jaccas.2026.110416