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Longer stent length, likely reflecting increased lesion length and plaque burden, predicted significant distal embolism during PCI in native vessel and vein graft lesions, as assessed by debris collected in a distal vascular protection device. This suggests that use of vascular protection devices should be considered during PCI of long lesions.

A 75-year-old man presented with typical angina 13 years after coronary artery bypass grafting. Angiography demonstrated a patent internal mammary graft to the left anterior descending artery and vein graft to the obtuse marginal branch of the left circumflex artery. The large-caliber right coronary graft had a large false aneurysm in its midportion, at the site of a severe stenosis. The aneurysm appeared to compress the graft distally. Three 17-mm polytetrafluoroethylene (PTFE)-covered stents (Abbott Vascular Devices) were each hand-crimped on a 5ϫ20-mm balloon and deployed with overlap across the neck of the aneurysm. Two baremetal stents (5ϫ28 mm and 5ϫ32 mm) were also deployed with overlap into the covered stents, to splint the PTFE stents within the aneurysm. A minor endoleak was present at the end of the procedure. Repeat angiography 6 weeks later showed complete exclusion of the false aneurysm and a widely patent stented segment (Figure).Vein graft false aneurysms are uncommon but may develop late after coronary artery bypass grafting surgery; they are usually atherosclerotic in origin. Traditionally, they have been treated by surgical excision or percutaneous coil embolization. This large false aneurysm was treated with multiple balloon-expanded PTFE-covered stents. A covered selfexpanding stent might also have been used to exclude the false aneurysm. DisclosuresNone.