A Novel Stent-in-Stent Scaffolding Technique for Percutaneous Exclusion of a Large Saphenous Vein Graft Pseudoaneurysm.

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.