ercutaneous transluminal coronary angioplasty (PTCA) occasionally causes the unexpected adverse effect of a coronary artery aneurysm, which is prone to rupture and thrombose and therefore requires repair. 1 With the increasing use of new devices, and newer ones appearing in quick succession, an increase in the frequency of this complication is expected. We describe here 2 cases of coronary artery aneurysm after PTCA, and their successful surgical repair.
Case Reports
Case 1A 60-year-old man developed severe post-infarction angina in December 1992. Coronary angiography (CAG) revealed 99% stenosis of the proximal left anterior descending coronary artery (LAD) and PTCA was performed, after which the residual stenosis was 50%. The patient was subsequently asymptomatic. However, the follow-up CAG after 1 month showed a small coronary artery aneurysm at the site of the previous PTCA. In April 1993, chest pain recurred and CAG showed an enlarging aneurysm and 75% restenosis of LAD and a new 75% stenosis of the distal circumflex coronary artery (CX) (Fig1). Coronary artery bypass grafting (CABG) and surgical repair of the aneurysm were therefore indicated.Surgery was performed in May 1993. The aneurysm was not visible on the heart surface, so we used a 0.5-mm angioscope (Olympus Optical Co, Ltd, Japan) to determine the site of the aneurysm. The angioscope was inserted through a small hole in the distal LAD, but, actually, little helpful information on the aneurysm was obtained through direct vision because of the scope's small caliber. The aneurysmal region of the proximal LAD, which was covered with thick epicardial fat, was identified and exposed through the guidance of the optic fiber light and the angiographical finding.The aneurysm was dissected longitudinally and plicated after removal of the mural thrombus. In addition, double CABG to the initial hole in the distal LAD with the left internal mammary artery and to the CX with the saphenous vein was performed.The postoperative course was uneventful and CAG at 1 month after the operation showed that the aneurysm had disappeared and both grafts were patent (Fig 1). We were not able to distinguish pseudoaneurysm from a true one histopathologically from the surgical specimen.
Case 2A 76-year-old man was admitted because of chest pain in October 1999. CAG showed an occlusion of the proximal LAD, and an ACS Multi-Link stent (3.0×15 mm) was implanted after PTCA. The target lesion had no residual stenosis, but the follow-up CAG 4 months after the first intervention showed restenosis at the distal site of the stent. A second PTCA using a cutting balloon (3.0×15 mm) was performed and extravasation of the contrast media was demonstrated at that time. Inflation of another balloon prevented further leakage, and the patient was discharged without subsequent complication. In May 2000, chest pain recurred and CAG demonstrated a 9.0×5.0 mm coronary artery aneurysm and restenosis at the proximal site of the stent (Fig 2). Therefore, revascularization and surgical repair of the ane...
The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.
The case of a 41-year-old man who developed an aneurysm in his aberrant left subclavian artery is described. The patient had a right aortic arch. After a successful aortosubclavian artery bypass, symptoms due to brain ischemia disappeared. This is a very rare disease that is sometimes associated with an aortic anomaly, therefore the optimal therapeutic procedure need to be carefully selected, including the operative indications and approach.
We assessed the change in intraoperative cerebral oxygen metabolism during coronary artery bypass grafting (CABG) in patients with cerebrovascular desease (CVD) identified by preoperative computed tomography or magnetic resonance imaging. The study population consisted of 36 patients who underwent consecutive CABG and were divided into two groups on the basis of preoperative CVD. With near-infrared spectroscopy, the change in oxygenated hemoglobin/total hemoglobin ratio (%Oxy-Hb), which was regarded as regional tissue oxygenation, was obtained. In addition, jugular venous bulb oxygen saturation (SjO2) was measured simultaneously. Moreover, the influence of intraoperative parameters on cerebral oxygenation was assessed by regression analysis.Thirteen patients (36%) were given a diagnosis of CVD preoperatively (group A) and were compared with the remaining 23 patients as controls (group B). All of group group B (p=0.12).In serial changes, %Oxy-Hb during the late phase of cardiopulmonary bypass (CPB) and SjO2 during the early phase of CPB were significantly lower in group A. The positive correlation between perfusion pressure and SjO2 was demonstrated in groupA (r=0.699, p< 0.0001) while no correlation was observed in group B. It is concluded that patiens with silent cerebral infarctions had poorer intraoperative cerebral oxygen metabolism during CABG. It is necessary to keep a higher perfusion pressure in these patients during CPB because cerebral autoregulation may be impaired.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.