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Niida T, Isoda K, Tada M, Kitahara S, Fujino Y. Successful healing of aneurysmal false lumen using a second-generation drug-eluting stent in spontaneous coronary artery dissection: a case report. Egypt Heart J 2024; 76:13. [PMID: 38300378 PMCID: PMC10834900 DOI: 10.1186/s43044-024-00447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/25/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND According to 2023 ESC Guideline, conservative medical management is generally recommended for the treatment of spontaneous coronary artery dissection (SCAD) except for patients with signs of ongoing myocardial ischemia. However, in some cases, invasive treatment (coronary artery bypass graft surgery or percutaneous coronary intervention (PCI)) is performed because of the progression of aneurysm in SCAD. Although there is no established strategy for the management of coronary aneurysm in SCAD, we report a case of successful healing of aneurysmal false lumen (AFL) using a second-generation drug-eluting stent (DES) in SCAD. CASE PRESENTATION A 44-year-old woman without any cardiovascular risk factors was transferred to our hospital due to inferior myocardial infarction. Coronary angiography (CAG) showed multiple SCADs in the coronary artery. We performed PCI to the distal right coronary artery (RCA) because the RCA showed severe stenosis (99%) with bradycardia. Six days after the first PCI, SCAD relapsed in the mid left anterior descending artery (LAD). Furthermore, AFL was observed by intravascular ultrasound imaging. To avoid enlargement of the AFL and progression of the dissection toward the proximal site of the LAD, we performed PCI to the mid LAD to seal the entry tear of the dissection using a second-generation DES. CAG revealed that the AFL in the mid LAD completely diminished at 1 year after PCI. CONCLUSIONS The implantation of a second-generation DES might be one of therapeutic options for sealing AFL in SCAD patients.
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Affiliation(s)
- Tomiharu Niida
- Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-8551, Japan.
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan.
| | - Kikuo Isoda
- Department of Cardiology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Miho Tada
- Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-8551, Japan
| | - Satoshi Kitahara
- Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-8551, Japan
| | - Yusuke Fujino
- Department of Cardiology, Kashiwa Kousei General Hospital, 617 Shikoda, Kashiwa, Chiba, 277-8551, Japan
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Lee T, Ashikaga T, Nozato T, Kaneko M, Miyazaki R, Okata S, Nagase M, Horie T, Terui M, Kishigami T, Nagata Y, Misawa T, Taomoto Y, Kachi D, Naito M, Yonetsu T, Sasano T. Predictors of coronary artery injury after orbital atherectomy as assessed by optical coherence tomography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023:10.1007/s10554-023-02837-7. [PMID: 37027104 DOI: 10.1007/s10554-023-02837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The association between the extent of the wire and device bias as assessed by optical coherence tomography (OCT) in the healthy portion of the vessel and the risk of coronary artery injury after orbital atherectomy (OA) has not been fully elucidated. Thus, purpose of this study is to investigate the association between pre-OA OCT findings and post-OA coronary artery injury by OCT. METHODS We enrolled 148 de novo lesions having calcified lesion required OA (max Ca angle > 90°) in 135 patients who underwent both pre- and post-OA OCT. In pre-OA OCT, OCT catheter contact angle and the presence or absences of guide-wire (GW) contact with the normal vessel intima were assessed. Also, in post-OA OCT, we assessed there was post-OA coronary artery injury (OA injury), defined as disappearance of both of intima and medial wall of normal vessel, or not. RESULTS OA injury was found in 19 lesions (13%). Pre-PCI OCT catheter contact angle with the normal coronary artery was significantly larger (median 137°; inter quartile range [IQR] 113-169 vs. median 0°; IQR 0-0, P < 0.001) and more GW contact with the normal vessel was found (63% vs. 8%, P < 0.001). Pre-PCI OCT catheter contact angle > 92° and GW contact with the normal vessel intima were associated with post-OA vascular injury (Both: 92% (11/12), Either: 32% (8/25), Neither: 0% (0/111), P < 0.001). CONCLUSION Pre-PCI OCT findings, such as catheter contact angle > 92° and guide-wire contact to the normal coronary artery, were associated with post-OA coronary artery injury.
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Affiliation(s)
- Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan.
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Tomoki Horie
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Mao Terui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Tetsuya Kishigami
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Toru Misawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Yuta Taomoto
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Daigo Kachi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Michihito Naito
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashinoshi, Tokyo, Tokyo, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Nakagawa T, Hara H, Wakiya M, Hiroi Y. Coil embolization for ruptured coronary pseudoaneurysm causing haemopericardium: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab129. [PMID: 34124560 PMCID: PMC8189297 DOI: 10.1093/ehjcr/ytab129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/02/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022]
Abstract
Background Coronary artery pseudoaneurysm is a rare disease that can rupture and cause haemopericardium. It can occur principally as a complication after coronary artery instrumentation, but it can also result from trauma. Case summary A 15-year-old male patient with a history of spontaneous pneumothoraces treated twice with video-assisted thoracoscopic thoracic surgery presented with pericarditis and increasing haemopericardium. During the hospitalization, he had developed cardiogenic shock and he underwent emergent pericardiocentesis. Coronary angiography revealed a small right coronary artery pseudoaneurysm. We successfully coil embolized the pseudoaneurysm. Discussion This is a rare case of a ruptured coronary artery pseudoaneurysm associated with prior tube thoracostomy. The treatments for a coronary pseudoaneurysm should be tailored based on the pathologic and anatomical characteristics.
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Affiliation(s)
- Takashi Nakagawa
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Momoko Wakiya
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
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Yoshida R, Takagi K, Morishima I, Tsuboi H. Coil embolization of pseudoaneurysm as a complication of excimer laser coronary angioplasty: insights from intravascular ultrasound and optical coherence tomography findings. J Med Ultrason (2001) 2018; 46:245-249. [PMID: 30306440 DOI: 10.1007/s10396-018-0908-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
Abstract
The occurrence of pseudoaneurysm in the coronary artery is rare and can develop after percutaneous coronary interventions. To date, the optimal therapy, including conservative, surgical, and endovascular therapies, for pseudoaneurysm in the coronary artery remains unclear. Here, we report a case of pseudoaneurysm arising as a complication of excimer laser coronary angioplasty, which was successfully treated with stent-assisted coil embolization, after which optical coherence tomography revealed complete healing of the pseudoaneurysm. This report highlights the feasibility of stent-assisted coil embolization for coronary pseudoaneurysms involving bifurcation.
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Affiliation(s)
- Ruka Yoshida
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-0864, Japan
- Department of Cardiology, Nagoya University, Nagoya, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-0864, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-0864, Japan.
| | - Hideyuki Tsuboi
- Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, 503-0864, Japan
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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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