Clinical presentation and outcomes of drug-eluting stent-associated coronary aneurysms

Coronary artery aneurysm formation after paclitaxel-coated balloon-only intervention for de novo coronary chronic total occlusion

Background

Although coronary artery aneurysm (CAA) is an uncommon complication of drug-coated balloon (DCB) treatment, the incidence and mechanisms CAA formation after DCB intervention for chronic total occlusion (CTO) remains to be clarified. The aim of this study was to investigate the incidence of CAA after DCB intervention for the treatment of CTO of coronary arteries.

Materials and methods

This was a retrospective analysis of 82 patients, contributing 88 vessels, who underwent successful DCB-only treatment for de novo CTO lesions. Follow-up angiography was performed in all cases, at a mean 208.5 (interquartile range [IQR]: 174.8 to 337.5) days after the index procedure.

Results

CAA was identified in seven vessels, in seven patients, at the site of previous successful DCB-only treatment. Of these, six were fusiform in shape and one saccular, with a mean diameter of 4.2 ± 1.0 mm and length of 6.7 ± 2.6 mm. Six CAAs developed at the CTO inlet site, and all CAAs occurred at the lesions following dissection immediately after DCB treatment. CAAs were not associated with an increased risk of major clinical events over the median follow-up of 676.5 (IQR: 393.8 to 1,304.8) days.

Conclusion

The incidence of CAA after DCB-only treatment for CTO lesions was 8.0% in this study. Further research is warranted, using intravascular imaging, to clarify the mechanism of DCB-related CAA formation and prognosis.

Coronary artery aneurysm following drug-coated balloon treatment

Drug-coated balloons are an effective treatment option for stent restenosis. Because of their potential benefits, the use of drug-coated balloons is predicted to increase in the future and expand further for the treatment of de novo lesions as well. We hereby present a case in which a patient developed a coronary artery aneurysm following the treatment of a de novo native coronary narrowing with a drug-coated balloon.

Very Late Development of Coronary Artery Aneurysm with Total Occlusion following Sirolimus-Eluting Stent Implantation

A 41-year-old African American woman presented with chest pain and was found to have non-ST segment elevation myocardial infarction with a peak cardiac troponin I of 28.5. Elective cardiac catheterization revealed a 70% ostial left anterior descending (LAD) artery stenosis. The patient underwent percutaneous coronary intervention and a sirolimus-eluting stent (Cypher, Miami, FL, 3.5 × 8 mm) was successfully deployed. Three years after stent implantation, the patient presented with recurrent angina. Repeat coronary angiography revealed a large aneurysm involving the proximal portion of the stent with a total occlusion at the mid to distal portion of the stent with collaterals to LAD from left circumflex artery. The patient underwent coronary artery bypass surgery with left internal mammary artery graft to LAD and ligation of LAD at its origin proximal to the aneurysm.

No indication for an unexpected high rate of coronary artery aneurysms after angioplasty with drug-coated balloons

AIMS

Coronary artery aneurysms (CAA) are a rare complication after percutaneous coronary intervention (PCI) and are reported with an incidence of 0.6% to 3.9%. While in recent years the use of paclitaxel drug-coated balloons (DCB) has increased, so far no CAA formation after DCB intervention has been reported.

METHODS AND RESULTS

During the years 2010 and 2011 we used DCBs in 704 PCIs. Follow-up angiography was scheduled at four months in all patients and has so far been achieved in 380 PCIs. In three patients we found development of a CAA at the former PCI site within four months of observation. Aneurysm length varied between 8.4 mm and 13 mm and lumina increased 58% to 131%. Retrospectively all patients with CAA development showed small intimal dissection partially with tiny persisting contrast bands parallel to the lumen according to type B and type C of the NHLBI classification after PCI.

CONCLUSIONS

CAA formation after DCB intervention was found in three out of 380 PCIs with DCB, consistent with an incidence of 0.8%. Thus, PCI with DCB does not cause an unexpectedly high rate of coronary artery aneurysms.