Drug eluting stent induced coronary artery aneurysm repair by exclusion. Where are we headed? (original) (raw)
Related papers
2009
We present a case of left anterior descending (LAD) coronary artery aneurysm at the site of previous stent placement 3 years previously. The patient presented with recent worsening of angina. Angiography and 64 slice CT angiography confirmed the presence of 6 mm aneurysm of LAD at the site of previous stent involving the origin of diagonal, with thrombus proximal and distal to the stent. This patient was successfully managed by taking the posterior wall of the anterior descending artery while suturing the heel of the left internal mammary artery (LIMA)-LAD anastomosis. The idea was to create severe stenosis upstream to prevent distal embolisation from the site of aneurysm. The diagonal was grafted with a saphenous venous graft. Follow-up angiogram at 3 months demonstrated successful exclusion of the aneurysm and unobstructed flow through the grafts.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
Most commonly, coronary artery aneurysms are secondary to atherosclerosis, but cases have been reported in patients who have vasculitis or tissue disorders, and in patients who have undergone interventional procedures. However, over the past few years, an increasing number of cases of coronary artery aneurysms after drug-eluting stent implantation have been reported. The exact mechanism is unknown. Experimental animal studies have shown that both the active drug and the polymer coating, under certain circumstances, might cause progressive luminal dilation, positive vascular remodeling, and aneurysmal formation. Complications like rupture, thrombosis, embolization, myocardial infarction, and even sudden death have been reported. Treatment options vary from aggressive surgical ligation of the aneurysm, in union with distal bypass surgery, to percutaneous implantation of a covered stent or conservative medical management with continued antiplatelet therapy. Currently, there is no consensus on an ideal approach to treating coronary artery aneurysm after drug-eluting stent implantation. Polytetrafluoroethylene-covered stents, easy and rapid to deploy, have emerged as a newer option. We report a case of coronary artery aneurysm at the site of a previous drug-eluting stent. The lesion was successfully treated with a polytetrafluoroethylene-covered stent.
Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report
University Heart Journal, 2017
Coronary artery aneurysms after coronary intervention are rare, the incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. Most "aneurysms" are in fact pseudoaneurysms rather than true aneurysms 1-4. Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high pressure balloon inflations, atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention 1-3. Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis 5,6 , but at the same time potentially causing coronary aneurysms due to other mechanisms, such as delayed reendothelialization, inflammatory changes of the medial wall, and hypersensitivity reactions 7-10. These findings may be due to delayed healing secondary to the antiproliferative action of the eluted drug, cell necrosis and/or apoptosis from the antimetabolite effect of the drug, and hypersensitivity reactions to the drug/polymer mixture on the DES 7-9. Systemic administration of antiinflammatory agents (glucocorticoids and colchicine) after stent implantation may be associated with a greater risk of aneurysm formation. 11 However, the true incidence, clinical course, and treatment of coronary artery aneurysms after DES implantation remain largely unknown. Case Report: Mr. X, 60 years old non smoker, non alcoholic, diabetic, hypertensive businessman got admitted in NICVD with complaint of ischaemic chest pain on minimal exertion for 3 months. ECG was within in normal limit, ETT was positive and Echocardiogram showed Anterior wall hypokinesia with EF-65%. CAG showed Significant long lesion in LAD. Direct stenting to LAD was done at the same setting with Promus Element (2.75×38mm, at 18 ATM).Whole procedure was uneventful and patient was discharged from hospital with double antiplatelet coverage. After 10 days of PCI patient got readmitted in hospital with complaints of chest discomfort with high grade fever for 2 days. ECG showed AMI (Extensive Anterior) indicating involvement of LAD territory with strong suspicion of Sub Acute Stent Thrombosis (SAST). Streptokinase could not be given due to delayed arrival. Patient was treated conservatively with LMWH. Blood and urine culture was negative. Check CAG was done 7 days after readmission showing Patent stent in LAD with aneurysmal dilatation at the distal end of stent in LAD.
Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Case Report
Cardiovascular Journal, 2013
Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth. However, several pathological studies have indicated that DES may delay healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. Mr. X, 60 years old diabetic, hypertensive got admitted in NICVD and was diagnosed as a case of Chronic Stable Angina. His ETT was strongly positive, CAG showed significant long lesion in LAD. Direct stenting with DES to LAD done and whole procedure was uneventful. After 10 days of PCI patient got readmitted in hospital with complaints of chest discomfort with high grade fever for 2 days. ECG showed AMI (Extensive Anterior) indicating involvement of LAD territory with strong suspicion of Sub Acute Stent Thrombosis (SAST). Strepto...
Treatment of a coronary artery aneurysm with a novel stent
Clinical Cardiology, 1999
We report a case of a prominent aneurysm of the right coronary artery secondary to atherosclerotic coronary artery disease. The aneurysm was complicated by recurrent myocardial infarction despite optimal medical treatment. It was successfully treated with coronary artery stenting, using a novel device, consisting of two stents with a layer of expandable graft material placed between them. Follow-up angiography 6 months after the procedure showed a sustained excellent result.
Coronary Artery Aneurysms After Drug-Eluting Stent Implantation
JACC: Cardiovascular Interventions, 2008
Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth. However, several pathological studies have indicated that DES may delay healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. However, the true incidence of coronary aneurysms in an unselected patient population is still largely unknown. This article reviews the published literature on coronary artery aneurysms specifically relating to DES. (J Am Coll Cardiol Intv 2008;1:14 -21)
International Journal of Cardiology, 2009
We report a case of acute myocardial infarction due to acute thrombosis of the right coronary artery just before a large atherosclerotic aneurysm. The patient was treated with primary percutaneous coronary angioplasty (PCA) and deployment of graft-coated stent with optimal final result. Patients with atherosclerotic coronary aneurysms usually show the same cardiovascular risk factors and the same clinical presentation of patients with atherosclerotic obstructive coronary artery disease, but with an increased risk of endovascular thrombosis and consequently more frequent episodes of distal coronary embolism. Furthermore, they may develop other specific complications, such as rapid aneurysm enlargement and rupture leading to cardiac tamponade. In conclusion, our report shows that percutaneous approach to coronary aneurysms with exclusion of aneurismal lumen by placement of graft-coated stent is a feasible and safety procedure even during the acute phase of myocardial infarction, and it may probably reduce the risk of subsequent distal embolization, improving myocardial perfusion.