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Gersch S, Baraki H, Toischer K. Progression and interventional therapy of a coronary pseudoaneurysm: a case report. Eur Heart J Case Rep 2022; 7:ytac478. [PMID: 36582593 PMCID: PMC9793774 DOI: 10.1093/ehjcr/ytac478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Background Coronary pseudoaneurysms (PSAs) occur as a rare complication following drug-eluting stent implantation and have been reported to occur between 1 week and 4 years after implantation. Most of them remain in a stable state, but progression of PSAs increases the risk of rupture and haemorrhagic cardiac tamponade. Case summary Here, we present a case of a 55-year-old patient, who developed a PSA of the proximal left circumflex artery after stent implantation of the left main artery, left anterior descending artery, and left circumflex artery. Within <1 year, the patient was readmitted to different hospitals due to cardiac decompensation and myocardial infarction. Thereafter, coronary angiography and computed tomography scans were performed, and progression of the PSA could be documented. Interventional therapy was chosen due to the high surgical risk of the patient. Implantation of a covered stent from the left main artery into the left anterior descending artery was chosen to treat the PSA, thereby silencing the chronically occluded left circumflex artery, followed by dilatation with a non-compliant balloon. The patient has remained asymptomatic in a 6-month follow-up. Discussion Coronary PSA should be controlled with respect to progression, and appropriate therapy can be chosen for treatment.
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Affiliation(s)
- Svante Gersch
- Department of Cardiology and Pneumology, University Medical School Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Hassina Baraki
- Department of Cardiovascular and Thoracic Surgery, University Medical School Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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2
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Kar S, Webel RR. Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: Rare anomaly with potentially significant clinical implications. Catheter Cardiovasc Interv 2017; 90:589-597. [PMID: 28258964 DOI: 10.1002/ccd.26997] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/17/2017] [Accepted: 01/28/2017] [Indexed: 12/20/2022]
Abstract
Spontaneous coronary artery pseudoaneurysm (PSA, false aneurysm) is an extremely rare occurrence with the precise incidence unknown. It is defined as an outwardly bulging monolayer or double layer within the coronary artery that lacks all 3 layers (intima, media, and adventitia) of the arterial wall. Coronary PSA commonly occurs from arterial dissection or perforation induced by catheter intervention, infection, pregnancy, or trauma. Traumatic dissection or perforation of the coronary artery after a percutaneous coronary intervention (PCI) remains the most common cause. Such cases may progress to myocardial ischemia, acute myocardial infarction, or acute coronary artery rupture causing death from cardiac tamponade. Intravascular ultrasound or cardiac computed tomography may aid in the diagnosis. Treatment options include PCI with a covered stent, bare or drug-eluting stent, coil embolization, coronary artery bypass graft with isolation of the PSA, or conservative management with vigilant clinical follow-up. In this review, we sought to describe the diagnosis, etiology, treatment, and the limited literature on spontaneous coronary artery PSA. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - Richard R Webel
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
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3
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Martínez-Quintana E, Rodríguez-González F. [Coronary pseudoaneurysm after percutaneous treatment of a coronary perforation]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 27:283-6. [PMID: 25977196 DOI: 10.1016/j.arteri.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 11/25/2022]
Abstract
Coronary pseudoaneurysms are rare and usually occur after percutaneous procedures, spontaneous dissections, aortocoronary bypass, or chest trauma. Although most of the cases are casual, other patients present as acute myocardial infarction, fistula formation or cardiac tamponade. We report the case of a coronary pseudoaneurysm after percutaneous treatment of a coronary perforation.
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Affiliation(s)
- Efrén Martínez-Quintana
- Servicio de Cardiología, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, España.
| | - Fayna Rodríguez-González
- Servicio de Oftalmología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
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Nunes RAB, Cade JR, Silva RC, Brito Júnior FS, Freitas HFG. Spontaneous closure of post-intervention left anterior descending coronary pseudoaneurysm. Rev Port Cardiol 2014; 33:381.e1-4. [PMID: 25012824 DOI: 10.1016/j.repc.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 02/27/2014] [Accepted: 03/01/2014] [Indexed: 11/25/2022] Open
Abstract
Coronary pseudoaneurysms are an unusual finding during coronary angiography and there are very little data on their prognosis in the literature. We report the case of a 62-year-old man admitted with an anterior myocardial infarction who developed a pseudoaneurysm in the mid left anterior descending artery some days after a type I coronary perforation during coronary angioplasty. Spontaneous closure of the pseudoaneurysm was observed during hospital follow-up. Spontaneous closure of coronary pseudoaneurysms may be more common in clinical practice than previously thought, but few cases have been reported. As the natural history of post-intervention coronary pseudoaneurysms has been little investigated, reports of their occurrence may help to clarify their evolution.
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Affiliation(s)
- Rafael A B Nunes
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School, Brazil.
| | - Jamil R Cade
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil
| | - Rafael C Silva
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | | | - Humberto F G Freitas
- Department of Cardiology, Hospital São Camilo Santana, São Paulo, Brazil; Heart Institute (InCor), University of São Paulo Medical School, Brazil
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Nunes RA, Cade JR, Silva RC, Brito Júnior FS, Freitas HF. Spontaneous closure of post-intervention left anterior descending coronary pseudoaneurysm. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Iatrogenic Giant Coronary Artery Pseudoaneurysm With “Daughter Aneurysm” Formation. J Thorac Imaging 2012; 27:W185-7. [DOI: 10.1097/rti.0b013e318255002c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Clinical utility of Doppler echocardiography in assessing aortic stenosis severity and predicting need for intervention in children. Pediatr Cardiol 2008; 29:507-14. [PMID: 18080153 DOI: 10.1007/s00246-007-9169-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/04/2007] [Accepted: 11/17/2007] [Indexed: 10/22/2022]
Abstract
The optimal echocardiographic methodology for predicting need for intervention in children with valvar aortic stenosis (VAS) is not known. We reviewed echocardiograms and catheterization reports of 79 children (aged 9.5 +/- 5.9 years) with isolated VAS. The maximum and mean Doppler-predicted gradients from the apical (MIGAP), MEGAP)) and the suprasternal or right parasternal (MIGHP), MEGHP)) windows were measured. The peak-to-peak catheterization gradient and the intervention (if any) were recorded. All sites and methods of Doppler estimation of VAS gradient correlated in a linear fashion with the invasive gradient (R2 = 0.34-0.50) and with one another (R2 = 0.48-0.86). MIGAP and MIGHP overestimated the invasive gradient in 60% and 86% of patients, whereas MEGAP and MEGHP underestimated the invasive gradient in 94% and 83% of patients, respectively. Age and diameter of the ascending aorta had small but significant effects on the level of agreement. A MIGHP < or = 55 mm Hg predicted no intervention with 100% accuracy, whereas the specificities of a MIGHP > 90 mm Hg, a MEGAP > 50 mm Hg, and a (MIGAP + MIGHP)/2 > 70 mm Hg for intervention were 94%, 100%, and 92%, respectively. The magnitude of overestimation was significantly lower from the apical window. In children with VAS, the best prediction of the catheterization gradient could be based on the average of MIGAP and MIGHP.
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Izutani H, Shibukawa T, Kawamoto J, Ishibashi K. Spontaneous right coronary artery pseudoaneurysm. Gen Thorac Cardiovasc Surg 2007; 55:259-61. [PMID: 17642282 DOI: 10.1007/s11748-007-0117-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 67-year-old man who had no history of coronary artery disease was found to have electrocardiographic abnormalities. Coronary angiography showed a proximal coronary artery aneurysm and total occlusion of the distal right coronary artery. He underwent coronary artery bypass grafting and repair of the right coronary artery aneurysm. The pathology of the resected aneurysm wall was compatible with a diagnosis of coronary pseudoaneurysm. Spontaneous coronary artery pseudoaneurysm is a rare condition that has the potential risk of rupture or ischemia. Surgical repair and adequate coronary revascularization are reasonable for a possible coronary artery pseudoaneurysm.
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Affiliation(s)
- Hironori Izutani
- Division of Cardiovascular Surgery, National Hospital Organization Kure Medical Center, 3-1 Aoyama-cho, Kure, Hiroshima 737-0023, Japan.
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Fessas CC, Mayer EK, Fessas CD. Search your heart for a cause of syncope! Br J Radiol 2007; 80:e64-6. [PMID: 17548504 DOI: 10.1259/bjr/54677520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 66-year-old female presented to casualty with recurrent syncopal episodes and a history of ischaemic heart disease. Initial investigations did not provide a definitive diagnosis. Subsequent CT scanning identified a giant pseudoaneurysm of the left anterior descending coronary artery, which is the largest reported to date. We include a short discussion on current literature surrounding coronary artery pseudoaneurysmal disease.
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Affiliation(s)
- Ch C Fessas
- Nicosia Heart Institute, 22 Heras St. and Archbishop Makarios Avenue, 1061 Nicosia, Cyprus.
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Porto I, MacDonald S, Banning AP. Intravascular ultrasound as a significant tool for diagnosis and management of coronary aneurysms. Cardiovasc Intervent Radiol 2005; 27:666-8. [PMID: 15593432 DOI: 10.1007/s00270-004-0038-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- I Porto
- Department of Cardiology, John Radcliffe Hospital, Headington, Oxford, England.
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Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography 2004; 21:175-82. [PMID: 14961799 DOI: 10.1111/j.0742-2822.2004.03050.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of myocardial ischemia and sudden death. Coronary aneurysms and pseudoaneurysms, which may occur after percutaneous coronary interventions, rarely occur spontaneously. We review the pertinent medical literature and describe the intravascular findings of spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms.
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Affiliation(s)
- Raed A Aqel
- Birmingham's Veterans Affairs Medical Center, Division of Cardiovascular Disease, Alabama 35233, USA.
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Gaspar J, Vonderwalde C, Eid-Lidt G. Treatment of coronary artery aneurysms by percutaneous sealing with bovine-pericardium-covered stents. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 2:241-246. [PMID: 12623575 DOI: 10.1080/acc.2.4.241.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The clinical significance of coronary artery aneurysms is briefly discussed. Until recently, surgical excision was the only treatment available. Single-case reports have documented aneurysm exclusion with vein-covered stents using 10 or 11 F. guiding catheters. This paper reports four patients with coronary artery aneurysms which were successfully excluded with the use of a novel pericardium-covered stent which is less invasive and shortens procedure time compared with the use of an autologous vein-grated stent and can be deployed using 8 F. or 9 F. guiding catheters. Short-term (five- to eight-month) clinical follow-up has been event-free in all patients, and in three patients six-month follow-up angiography has shown insignificant luminal loss.
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Affiliation(s)
- Jorge Gaspar
- Department of Interventional Cardiology, Instituto Nacional de Cardiología, Mexico City, Mexico
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Fukutomi T, Suzuki T, Popma JJ, Hosokawa H, Yokoya K, Inada T, Hayase M, Kondo H, Ito S, Suzuki S, Itoh M. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. Circ J 2002; 66:349-56. [PMID: 11954948 DOI: 10.1253/circj.66.349] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary perforation is a rare but serious complication that occurs during percutaneous coronary intervention (PCI). This study examines the frequency of coronary perforation during PCI, evaluates the management strategies used to treat perforations, and describes the long-term prognosis of patients who have developed coronary perforation during PCI. Coronary perforations were found in 69 (0.93%) of 7,443 consecutive PCI procedures, occurring more often after use of a new device (0.86%) than after use of balloon angioplasty (0.41%) (p<0.05). Coronary perforation was attributable solely to the coronary guidewire in 27 (0.36%) cases. Coronary perforations were divided into 2 types: (1) Those with epicardial staining without ajet of contrast extravasation (type I, n=51), and (2) those with a jet of contrast extravasation (type II, n= 18). Patients with type I and type II perforations were managed by observation only (35% and 0%, respectively), reversal of anticoagulation (57% and 94%), pericardiocentesis and drainage (27% and 61%), and prolonged perfusion balloon angioplasty (16% and 100%). Two patients with type II perforations required emergency coronary artery bypass surgery. There were no in-hospital deaths. Late pseudoaneurysms developed in 18 (28.6%) patients during the 13.4 +/- 11.3 months' follow-up period, and were more common in patients with type II perforations (72.2% vs 11.1% with type I perforations; p<0.001). During the follow-up period, no patient had evidence of coronary rupture. The results suggest that coronary perforation is uncommon after PCI, and can be managed without cardiac surgery in the majority of cases. Late pseudoaneurysms developed in some patients, particularly in patients with type II perforations, but there were no late consequences of coronary perforation after PCI.
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Affiliation(s)
- Tatsuya Fukutomi
- The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Aichi, Japan.
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Maehara A, Mintz GS, Ahmed JM, Fuchs S, Castagna MT, Pichard AD, Satler LF, Waksman R, Suddath WO, Kent KM, Weissman NJ. An intravascular ultrasound classification of angiographic coronary artery aneurysms. Am J Cardiol 2001; 88:365-70. [PMID: 11545755 DOI: 10.1016/s0002-9149(01)01680-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to use intravascular ultrasound (IVUS) to clarify the morphology of coronary aneurysms diagnosed by angiography. Seventy-seven consecutive patients with an aneurysmal dilatation in a native coronary artery diagnosed by angiography (defined as a lesion lumen diameter 25% larger than reference) were evaluated by IVUS. IVUS true aneurysms were defined as having an intact vessel wall and a maximum lumen area 50% larger than proximal reference. IVUS pseudoaneurysms had a loss of vessel wall integrity and damage to adventitia or perivascular tissue. Complex plaques were lesions with ruptured plaque or spontaneous or unhealed dissection. Aneurysmal dilatation and reference segments were assessed using standard IVUS quantitative techniques. Twenty-one lesions (27%) were classified as true aneurysms, 3 (4%) were classified as pseudoaneurysms, 12 (16%) were complex plaques, and the other 41 (53%) were normal arterial segments adjacent to > or =1 stenosis. The maximum lumen area within the aneurysmal segment was largest for pseudoaneurysm (35.1 +/- 10.4 mm(2)), 22.1 +/- 9.9 mm(2) for true aneurysm, and similar for complex plaques (11.2 +/- 3.5 mm(2)) and normal segments with adjacent stenoses (13.8 +/- 6.4 mm(2)): analysis of variance, p <0.0001. Only one third of angiographically diagnosed aneurysms had the IVUS appearance of a true or pseudoaneurysm. Instead, most angiographically diagnosed aneurysms had the morphology of complex plaques or normal segments with adjacent stenoses.
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Affiliation(s)
- A Maehara
- Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA
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