Journal of Invasive Cardiology

Since it was first used in 1984 and reported in 1987,1,2 the right gastroepiploic artery (RGEA) has emerged as an effective third or isolated arterial conduit for complete arterial bypass grafting or for use in cases of limited graft numbers or poor quality vein for grafts.3–5 The RGEA can be used as a pedicled or free graft with or without cardiopulmonary bypass.6 The RGEA grafts are superior to vein grafts, with > 95% short-term patency rates and actuarial 5-year patency rates of 80–85%,7–9 with a 5-year survival rate > 92%.5,9 Ischemic events related to pedicled RGEA grafts result from disease progression in the native coronary arteries, or spasm, occlusion or stenosis of the graft, especially at the coronary artery anastomotic site7 that has been successfully treated with percutaneous angioplasty10–12 and/or stenting.13,14 Little is known about the restenosis rate of RGEA grafts. We report a case of percutaneous coronary stenting of an RGEA bypass graft lesion subsequently complicated by in-stent restenosis that was treated with brachytherapy from the left axillary approach. We review the existing published experience with GEA bypass graft coronary interventions.