Giant Coronary Artery Pseudoaneurysm after Drug-Eluting Stent Implantation

Bhupali, Ashok; Joshi, Amit; Patil, Sachin; Jadhav, Prithiviraj; Prasad, Sayi; Vora, Tanmay; Gajiwala, Nirlep; Thakkar, Ashok

doi:10.4236/ijcm.2015.68074

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Using the PRISMA methodology, 36 articles 1‐36 were identified that fulfilled criteria of PSA after stenting in an atherosclerotic lesion in the absence of concomitant infection (Figure 2). With the addition of the present case report (please see below), there are 37 well‐documented and reported coronary PSA cases (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

Hassan

Uretsky

Estrada

et al. 2020

Cathet Cardio Intervent

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Pseudoaneurysm (PSA) formation is a rare but well‐known complication of coronary stenting. It develops after a procedural perforation disrupts the integrity of the vessel wall but is contained by a single wall layer, usually pericardium, extravascular thrombosis and later fibrosis. Medical literature of PSA consists primarily of case reports. A systematic review of pseudoaneurysm after coronary stenting was performed to summarize its presentation, diagnostic imaging modalities, natural history, and management approaches. Clinical presentations range from asymptomatic to hemodynamic collapse, size from small to “giant,” and treatment approaches from surgical or percutaneous exclusion to “watchful waiting” and imaging surveillance. Based on current information, a management algorithm is provided recommending urgent to emergent exclusion for symptomatic PSA, elective exclusion for large and giant PSA, and “watchful waiting” and periodic imaging surveillance for small to moderate sized PSA.

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Section: Resultsmentioning

confidence: 99%

“…Pseudoaneurysm (PSA) formation is a rare but well‐known complication of coronary stenting 1‐36 . It develops after a perforation disrupts the integrity of the vessel wall but is contained by extravascular thrombosis, fibrosis, and pericardial constraint.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

Hassan

Uretsky

Estrada

et al. 2020

Cathet Cardio Intervent

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Transcatheter embolization of a giant coronary artery pseudoaneurysm

Dalal

Varma

Chakravorty

et al. 2018

Cardiovascular Revascularization Medicine

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A case report of pseudoaneurysm of coronary artery within a month of percutaneous coronary intervention

Sharma¹,

Ruia²

2022

European Heart Journal - Case Reports

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Background Coronary artery pseudoaneurysms (PSAs) are uncommon and have poorly understood natural history. Unlike true aneurysms, PSAs do not have all the three layers of the vessel in the aneurysmal wall. PSAs are most commonly seen after an overzealous percutaneous coronary intervention (PCI) which causes damage to the vessel wall. They usually develop slowly after PCI and PSAs within a month of a PCI are not so common. PSA may be asymptomatic or present with recurrent angina. Case summary Here, we report a case of symptomatic PSA to right coronary artery (RCA). The patient had a myocardial infarction for which a PCI was performed to deploy a drug eluting stent (DES) in the RCA. The patient had in-stent restenosis (ISR) within a week of PCI for which plain old balloon angioplasty (POBA) was performed. The patient continued to have unstable angina and within a month of POBA was diagnosed as a case of PSA by intravascular ultrasound. A covered stent was deployed which effectively sealed off the PSA and resumed normal blood flow to distal vessel. Patient has been doing well on medication (aspirin75 mg once daily, atorvastatin 80 mg once daily, and P2Y12 platelet inhibitor [Ticagrelor] 90 mg twice daily). Discussion PSA usually tale six to nine months to develop. However, PSAs have been reported within one to two months of PCI. This case also shows that PSAs can occur within a month of PCI. It is possible that over-aggressive and/or high pressure dilatation and/or deep engagement during POBA performed to open up the ISR could have damaged the struts of the DES and compressed it against the vascular wall. The resultant vascular wall injury could have been the cause of early PSA formation in this case. Hence, cardiologists should be vigilant enough to suspect PSA, especially in a patient presenting with angina. The case also shows that covered stents are a viable option to treat early presentations of PSA.

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Giant Coronary Artery Pseudoaneurysm after Drug-Eluting Stent Implantation

Cited by 3 publications

References 9 publications

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

Transcatheter embolization of a giant coronary artery pseudoaneurysm

A case report of pseudoaneurysm of coronary artery within a month of percutaneous coronary intervention

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