Use of the float-moor-crush approach for subtotal mid-segment collapse of a protruding aorto-ostial vein graft stent: a case report

INTRODUCTION: Aorto-ostial stenting remains one of the most demanding and risky types of angioplasty to perform. We report a case outlining a creative solution for the reengagement of a protruding aorto-ostial stent. CASE PRESENTATION: A 69-year-old Caucasian man was admitted to our hospital's coronary care unit with progressive unstable angina five years following coronary artery bypass grafting and three years after percutaneous coronary intervention of the graft. Several attempts to engage the protruding part of the aorto-ostial stent in the graft failed. A catheter was eventually floated towards the protruding part using a wire to moor the catheter to the stent through the side-strut. The proximal part of the protruding stent was subsequently crushed with a new stent. Stent patency was observed 12 months after the procedure was performed. CONCLUSION: Although careful cannulation of a aorto-ostial stent during repeat coronary angiography coupled with the placement of a guidewire and stent through the true stent lumen during repeat intervention remains the ideal approach for aorto-ostial in-stent restenosis, this case report confirms the feasibility of the side-strut stenting technique in reaching a long-term positive outcome.