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Khubber S, Chana R, Meenakshisundaram C, Dhaliwal K, Gad M, Kaur M, Banerjee K, Verma BR, Shekhar S, Khan MZ, Khan MS, Khan S, Sammour Y, Tsutsui R, Puri R, Kalra A, Bakaeen FG, Simpfendorfer C, Ellis S, Johnston D, Pettersson G, Kapadia S. Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management. Open Heart 2021; 8:openhrt-2020-001440. [PMID: 33568555 PMCID: PMC7878141 DOI: 10.1136/openhrt-2020-001440] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies. METHODS We performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years. RESULTS We identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates. CONCLUSION Our analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.
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Affiliation(s)
- Shameer Khubber
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rajdeep Chana
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Kamal Dhaliwal
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohomed Gad
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kinjal Banerjee
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Beni Rai Verma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shashank Shekhar
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhummad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | | | - Safi Khan
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rayji Tsutsui
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rishi Puri
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankur Kalra
- Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Faisal G Bakaeen
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Stephen Ellis
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Douglas Johnston
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gosta Pettersson
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Unique Findings and Novel Treatment Strategy of a Giant Coronary Artery Aneurysm Associated with a Significant Pericardial Effusion. Case Rep Cardiol 2020; 2020:8890806. [PMID: 32566321 PMCID: PMC7303761 DOI: 10.1155/2020/8890806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
Giant coronary artery aneurysms are a rare, asymptomatic occurrence. Presently, there is a lack of substantial research performed in the U.S., likely due to its low prevalence. As we are increasingly becoming a global community, strengthening data for seemingly rare disease processes such as this need to be addressed, particularly when they can progress to involve complications such as pericardial effusion caused by aneurysmal rupture or infection. A popular treatment option for these aneurysms is polytetrafluoroethylene-covered stents; they have been favorable with obtaining a high percentage of procedural success rates in aneurysms not associated with myocardial infarctions. In this paper, we present a case of a giant coronary artery aneurysm located in the left circumflex coronary artery that was complicated by a pericardial effusion. We will also present its unusual repair using a long drug-eluting stent as a scaffold to overlap covered coronary stents used to help exclude the aneurysm.
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Miller EO, Krishnamoorthy VK, Ling FSK, Chaturvedi A, Cameron SJ. A man with chest pain and acute ST elevations on electrocardiogram. BMJ 2017; 357:j2198. [PMID: 28522610 PMCID: PMC6887831 DOI: 10.1136/bmj.j2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Erica O Miller
- Department of Medicine, Division of Cardiovascular Disease, University of Rochester, New York, USA
| | - Vijay K Krishnamoorthy
- Department of Medicine, Division of Cardiovascular Disease, University of Rochester, New York, USA
| | - Frederick S K Ling
- Department of Medicine, Division of Cardiovascular Disease, University of Rochester, New York, USA
| | | | - Scott J Cameron
- Department of Medicine, Division of Cardiovascular Disease, University of Rochester, New York, USA
- Aab Cardiovascular Research Institute, University of Rochester, New York
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Fry J, Naqvi A, Bahia A, Seto A. Aspiration thrombectomy and intracoronary tirofiban via GuideLiner ® catheter for a thrombosed aneurysmal vessel. Future Cardiol 2017; 13:131-135. [PMID: 28169555 DOI: 10.2217/fca-2016-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A 52-year-old Asian male with no traditional risk factors for coronary artery disease presented with acute coronary syndrome. Coronary angiography showed complete thrombotic occlusion of the left circumflex with a large thrombus burden in the setting of diffuse aneurysmal enlargement of the coronary arteries consistent with antecedent Kawasaki disease. Manual thrombectomy with adjunctive intracoronary tirofiban was performed utilizing the GuideLiner catheter® (Vascular Solutions, Inc., MN, USA). Stent implantation was deferred. Follow-up imaging 48 h later showed preserved coronary flow and decreased thrombus burden. The GuideLiner catheter, a monorail guiding device, served a novel role in thrombus aspiration and intracoronary medication delivery.
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Affiliation(s)
- James Fry
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
| | - Ali Naqvi
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
| | - Amit Bahia
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
| | - Arnold Seto
- Department of Medicine, University of California, Irvine, 101 The City Drive, Suite #400, Orange, CA 92868, USA
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Crawley PD, Mahlow WJ, Huntsinger DR, Afiniwala S, Wortham DC. Giant coronary artery aneurysms: review and update. Tex Heart Inst J 2014; 41:603-8. [PMID: 25593524 DOI: 10.14503/thij-13-3896] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention. Most giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. Clinical sequelae include thrombus formation, embolization, fistula formation, and rupture. Surgical correction is generally accepted as the preferred treatment for giant coronary artery aneurysms. We present an illustrative case of a giant 70 × 40-mm coronary artery aneurysm in a 56-year-old man who declined surgery and died one month later. In addition, we provide a review of the medical literature on giant coronary artery aneurysms.
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