Coronary Aneurysms After Drug-Eluting Stent Implantation

Alfonso, Fernándo; Pérez-Vizcayno, María-José; Ruiz, M. Colmenero; Suárez, Alfonso; Cazares, Miguel; Hernández, Rosana; Escaned, Javier; Bañuelos, Camino; Jiménez‐Quevedo, Pilar; Macaya, Carlos

doi:10.1016/j.jacc.2009.01.069

Cited by 142 publications

(40 citation statements)

References 34 publications

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“…Our findings are also corroborated by a recent cohort study in patients who had undergone DES implantation. During a mean follow-up period of 399 days, Alfonso et al (27) reported a coronary artery aneurysm rate of 1.3% after DES implantation. In 4 of 15 patients with a documented aneurysm, the aneurysm was found at the zone of stent overlap, which suggests excessive vessel remodeling as a result of the high density of drug or polymer.…”

Section: Discussionmentioning

confidence: 99%

Impact of Stent Overlap on Angiographic and Long-Term Clinical Outcome in Patients Undergoing Drug-Eluting Stent Implantation

Räber

Jüni

Löffel

et al. 2010

Journal of the American College of Cardiology

150

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Section: Discussionmentioning

confidence: 99%

Impact of Stent Overlap on Angiographic and Long-Term Clinical Outcome in Patients Undergoing Drug-Eluting Stent Implantation

Räber

Jüni

Löffel

et al. 2010

Journal of the American College of Cardiology

150

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“…The overall incidence of CAAs ranges from 0.3 to 5.3%; a pooled analysis states a mean incidence of 1.65% (1–8). The incidence of giant CAAs is as low as 0.02%, while the incidence of those associated with congenital artery fistulae are 5.9% (3).…”

Section: Epidemiologymentioning

confidence: 99%

Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment

Sherif

Tok

Taşköylü

et al. 2017

Front. Cardiovasc. Med.

197

189

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Coronary artery aneurysms (CAAs) are uncommon and describe a localized dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. The incidence of CAAs varies from 0.3 to 5.3%. Ever since the dawn of the interventional era, CAAs have been increasingly diagnosed on coronary angiography. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the management of CAAs, and emerging findings support the importance of an early diagnosis in patients predisposed to CAAs, such as in children with KD. This review aims to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of this disease.

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“…1 Hypersensitivity vasculitis has been noted with first generation DES [1][2][3] ; however, it has rarely been described after EES implantation 4 and, to our knowledge, never within 3 weeks of implantation. As such, this would be the earliest report of aneurysm formation after EES implantation.…”

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confidence: 99%

“…There were 90% in-stent restenoses proximal and distal to the aneurysm (Figure [D]). The D1 and OM1 remained occluded.Although the polymers used for drug-delivery in drug-eluting stents (DES) are highly biocompatible, they can rarely incite a severe inflammatory reaction consisting of eosinophils and lymphocytes involving all 3 arterial layers, leading to aneurysm formation and significantly increasing the risk of stent thrombosis.1 Hypersensitivity vasculitis has been noted with first generation DES [1][2][3] ; however, it has rarely been described after EES implantation 4 and, to our knowledge, never within 3 weeks of implantation. As such, this would be the earliest report of aneurysm formation after EES implantation.…”

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confidence: 99%

Early Aneurysm Formation After Everolimus-Eluting Stent Implantation

Kadakia

Epps

Julien

et al. 2014

Circ: Cardiovascular Interventions

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A 65-year-old woman with hypertension and dyslipidemia presented with rest chest pain in the setting of 2 mm ST depression in ECG leads V3-V6 and a troponin T level (TnT) of 0.92 ng/mL (normal, <0.08 ng/mL). Emergent cardiac catheterization, performed for the non-ST elevation myocardial infarction (NSTEMI), revealed a 60% proximal left anterior descending artery (LAD) bifurcation lesion involving an 80% lesion in the first diagonal branch (D1) and a 90% first obtuse marginal artery (OM1) lesion (Figure [A]). Fractional flow reserve (FFR) of the LAD was 0.78, and the LAD was successfully treated with a bifurcation approach using a 2.75×12 mm everolimus-eluting stent (EES, Xience Prime, Abbott Vascular, Redwood City, CA) in the LAD and a 2.25×20 mm EES (Promus Element, Boston Scientific, Natick, MA) in D1; both deployed at 10 atmospheres (atm). The OM1 was treated with a 2.25×12 mm EES (Xience Prime) deployed at 10 atm. Full details of coronary interventions are available in the Data Supplement. There was no angiographic evidence of dissection or incomplete expansion after stent placement. She was discharged on dual antiplatelet therapy.Seventeen days later, she presented again with chest pain, new anterior T-wave inversions on ECG, and TnT of 0.24 ng/ mL. Catheterization showed aneurysm formation at the LAD and OM1 stent sites with occlusion of a distal LAD branch (Figure [B]), suggestive of localized hypersensitivity vasculitis with thrombus formation within the aneurysm and embolization to the distal LAD. There were no systemic signs of hypersensitivity such as fever, leukocytosis, or eosinophilia. Given the short time frame of aneurysm formation, coronary artery bypass surgery was performed with a left internal mammary artery to the LAD and saphenous vein grafts to D1 and OM1. The LAD, D1, and OM1 were ligated distal to the stents to prevent further thromboembolism from the aneurysms. On gross examination of the heart surface during surgery, the epicardial tissue and fat were noted to be highly inflamed, erythematous, and indurated. The patient returned for surveillance catheterization 6 weeks later. This demonstrated a slightly diminished LAD aneurysm and occluded D1 and OM1 with patent grafts (Figure [C]).The patient presented again 4 months later with chest pain. ECG demonstrated ST depressions and T-wave inversions in V2-V6. TnT was 0.45 ng/mL. Emergent cardiac catheterization demonstrated significant enlargement of the LAD aneurysm. There were 90% in-stent restenoses proximal and distal to the aneurysm (Figure [D]). The D1 and OM1 remained occluded.Although the polymers used for drug-delivery in drug-eluting stents (DES) are highly biocompatible, they can rarely incite a severe inflammatory reaction consisting of eosinophils and lymphocytes involving all 3 arterial layers, leading to aneurysm formation and significantly increasing the risk of stent thrombosis.1 Hypersensitivity vasculitis has been noted with first generation DES [1][2][3] ; however, it has rarely been described after EES implantation 4 an...

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Coronary Aneurysms After Drug-Eluting Stent Implantation

Abstract: After DES implantation, CANs are rare and may be detected in asymptomatic patients. However, CANs are frequently associated with adverse clinical events as a result of DES restenosis and DES thrombosis. Further studies are required to determine the implications of this distinct new entity.

Cited by 142 publications

References 34 publications

Impact of Stent Overlap on Angiographic and Long-Term Clinical Outcome in Patients Undergoing Drug-Eluting Stent Implantation

Impact of Stent Overlap on Angiographic and Long-Term Clinical Outcome in Patients Undergoing Drug-Eluting Stent Implantation

Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment

Early Aneurysm Formation After Everolimus-Eluting Stent Implantation

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