Stent thrombosis with an aneurysm 7 years after a drug eluting stent implantation

Outcomes of patients who undergo elective covered stent treatment for coronary artery aneurysms

BACKGROUND

Coronary artery aneurysms (CAA) are reported in up to 5% of patients undergoing coronary angiography. Treatment of CAAs with covered stents has been reported in several case reports, however there is limited evidence available on the effectiveness and safety of this interventional practice.

PURPOSE

To evaluate the current practice and outcomes of elective treatment of coronary artery aneurysms with covered stents.

METHODS

We conducted a systematic review of published case reports and case series of patients presenting with CAA that have been treated with covered stents in a non-emergency setting.

RESULTS

A total of 63 case reports and 3 case series were included in the final analysis comprising data from 81 patients. The treated CAA was situated in a native coronary artery in 92.6%, and in a saphenous vein graft in 7.4%. Procedural success was achieved in 95.1%. The types of stents used were mainly polytetrafluoroethylene (75.3%) and Papyrus (11.1%). In 11.0% of cases additional abluminal drug eluting stents (DES) and in 6.8% additional adluminal DES were implanted. After a mean follow up of 13.4 months overall major adverse cardiovascular events (MACE), mortality, myocardial infarction, stroke, stent thrombosis and target lesion revascularization were reported in 26.2, 0.0, 7.6, 0.0, 4.6 and 18.5% of cases, respectively.

CONCLUSIONS

The use of covered stents for elective treatment of CAA appears to be effective and reasonably safe. Nevertheless, it is associated with higher MACE rate, driven mainly by higher target lesion revascularization. Further studies, particularly in form of randomized trials and controlled registries are warranted to identify patients who might profit the most from this procedure.

Proximal Left Main Coronary Artery Aneurysm Presenting as ST-Elevation Myocardial Infarction Treated by Stenting

Coronary artery aneurysm (CAA) is a rare cardiac anomaly with a reported incidence of 0.3-4.9% of patients who undergo coronary angiography. The term is used when the coronary artery diameter exceeds more than 50% or 1.5 times the reference diameter. It can be congenital or acquired. The commonest acquired cause in an adult is atherosclerosis and in a child is Kawasaki's disease. The commonest culprit vessel is the Right Coronary Artery (RCA), followed by Left Circumflex (LCx) and Left Anterior Descending (LAD). Left main coronary aneurysms are extremely rare in clinical practice. Coronary angiography is the gold standard procedure, both for diagnosis and treatment. We report a 49-year-old male who presented with anterior wall ST-Elevation Myocardial Infarction (STEMI). The initial angiography showed LAD stent thrombosis, but when the second angiography was done, there was spontaneous recanalization of the LAD. Coronary angiography was performed at our hospital, which revealed a long left main coronary artery aneurysm measuring 9.8 mm-maximum diameter. This was treated with a size 5 × 24 mm Begraft coronary stent.

The MGuard coronary stent: safety, efficacy, and clinical utility

Atheromatous and thrombotic embolization during percutaneous coronary revascularization is a feared complication that may cause impaired myocardial reperfusion even with a patent epicardial vessel. The MGuard stent is a cobalt chromium bare metal stent with a porous net attached to its outer surface that has been designed to prevent thrombus fragmentation and distal embolization during stent implantation. This review summarizes the available evidence supporting the use of the MGuard stent in different scenarios such as lesions with high thrombus burden, saphenous vein graft interventions, coronary perforations, or carotid lesions.