Vascular responses to a Viabahn stent graft: evaluation with computed tomographic angiography, angiography, and angioscopy

Excerpt

A 72-year-old woman with persistent atrial fibrillation underwent an implantation of a heparin-bonded expanded polytetrafluoroethylene (ePTFE)-covered stent (Viabahn, W. L. Gore, Flagstaff, AZ, USA) in her superficial femoral artery (SFA) with severe stenosis including yellow plaques (Fig. 1a, e). The distal reference vessel diameter measured by intravascular ultrasound was 4.5 mm × 5.1 mm. After the implantation of the Viabahn (5 mm × 100 mm), a final angiogram showed it had well-expanded (Fig. 1c). She received uninterrupted antithrombotic therapy with adjusted-dose warfarin and aspirin after the procedure. One year later, duplex ultrasound showed no in-stent restenosis, and a follow-up computed tomographic angiogram showed no in-stent restenosis except at the stent edges, which were unevaluable because of metallic artifact (Fig. 1b). To manage the antithrombotic therapy, follow-up angiography was performed and confirmed there was no in-stent restenosis (Fig. 1d), and angioscopy detected yellow plaques seen through the ePTFE, mural thrombi without neointima coverage (Fig. 1f; Supplement Movie 1), and a small gap between the proximal stent edge and luminal vessel wall (Fig. 1f; Supplement Movie 2), which might have been caused by a weak radial force.

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