Coronary Artery Aneurysm after Second-Generation Drug-Eluting Stent Implantation

Treatment of coronary pseudoaneurysm detected after percutaneous coronary intervention for chronic total occlusion: A case report

BACKGROUND

Coronary pseudoaneurysm (CPA) are associated with iatrogenic coronary artery dissection or perforation, which rarely reported formation early after percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study reported a case of CPA that developed 4 weeks after PCI for CTO.

CASE REPORT

A 40-year-old man was admitted with unstable angina and diagnosed with CTO of the left anterior descending artery (LAD) and right coronary artery. The CTO of the LAD was successfully treated by PCI. However, reexamination by coronary arteriography and optical coherence tomography after 4 weeks confirmed a CPA at the stented middle segment of the LAD. The CPA was treated surgically by the implantation of a Polytetrafluoroethylene-coated stent. reexamination at the 5-month follow-up revealed a patent stent in the LAD and no CPA-like manifestations. Intravascular ultrasound showed no intimal hyperplasia or in-stent thrombogenesis.

CONCLUSION

CPA might develop within weeks after PCI for CTO. While it could be successfully treated by the implantation of a Polytetrafluoroethylene-coated stent.

Coronary Artery Aneurysms as a Cause of Acute Coronary Syndrome Presentation - A Focused Review

Coronary artery aneurysms (CAA) are defined as a dilation of a coronary vessel greater than 1.5 times the diameter of a local reference vessel. While CAAs tend to be incidental findings on imaging, they result in complications, such as thrombosis, embolization, ischemia, arrhythmias, and heart failure. Among symptomatic cases, chest pain has been the most common manifestation of CAAs. This necessitates an understanding of CAAs as a cause of acute coronary syndrome (ACS) presentation. However, due to the unclear pathophysiology of CAAs and their variable presentation complicated by similar ACS conditions, there is no clear strategy for CAA management. In this article, we will discuss the contribution of CAAs to ACS presentations and review the current management options for CAAs.

Progressive growth of coronary aneurysms after bioresorbable vascular scaffold implantation: Successful treatment with OCT-guided exclusion using covered stents

The development and progressive enlargement over time of multiple saccular coronary artery aneurysms (CAA) after implantation of everolimus‐eluting stent and bioresorbable vascular scaffolds (BVS) have been reported. CAA was successfully excluded by two overlapped covered stents expanded inside a long metallic drug‐eluting stent to avoid dislodgment at the overlap point. Optical coherence tomography (OCT) was repeatedly performed to monitor CAA expansion and to guide treatment through precise measurement of aneurysm length and vessel size at the landing zone. At 10‐month follow‐up, coronary computed tomography angiography showed persistent CAA exclusion. To the best of our knowledge, this is the first report of this technique to exclude a long CCA segment.

Long-term Clinical Outcomes of Drug-Eluting Stent Malapposition

Previous pathologic, intravascular imaging, and clinical studies have investigated the association between adverse cardiac events and stent malapposition, including acute stent malapposition (ASM, that is detected at index procedure) and late stent malapposition (LSM, that is detected during follow-up) that can be further classified into late-persistent stent malapposition (LPSM, ASM that remains at follow-up) or late-acquired stent malapposition (LASM, newly developed stent malapposition at follow-up that was not present immediately after index stent implantation). ASM has not been associated with adverse cardiac events compared with non-ASM, even in lesions with large-sized malapposition. The clinical outcomes of LSM may depend on its subtype. The recent intravascular ultrasound studies with long-term follow-up have consistently demonstrated that LASM steadily increased the risk of thrombotic events in patients with first-generation drug-eluting stents (DESs). This association has not yet been identified in LPSM. Accordingly, it is reasonable that approaches to stent malapposition should be based on its relationship with clinical outcomes. ASM may be tolerable after successful stent implantation, whereas prolonged anti-thrombotic medications and/or percutaneous interventions to modify LASM may be considered in selected patients with first-generation DESs. However, these treatments are still questionable due to lack of firm evidences.