Sequential coronary angiograms unveil the progression of an acquired coronary aneurysm

Bellotti, S; Iannone, Alessandro; Rubartelli, Paolo

doi:10.1093/eurheartj/eht146

Cited by 3 publications

(4 citation statements)

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“…aneurysm ligation, placation or resection with or without revascularization, has a 1-2% operative risk comparable to coronary artery procedures [ 1 , 2 , 3 , 7 ]. Percutaneous treatment of CAA to exclude CAAs with a bare metal stent, a covered stent or coil embolization has been suggested as a safe procedure in several case reports [ 1 , 2 , 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stent placement has been reported as an emerging cause of iatrogenic CAA [ 2 ]. The complications of CAA include thrombosis, distal embolization, rupture and coronary spasms [ 1 , 4 ] and therefore treatment is sometimes indicated. Hence, we report a case of a CAA treated with stent placement that further required an urgent cardiac operation.…”

Section: Introductionmentioning

confidence: 99%

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From Small Coronary Artery Aneurysm to Giant Left Ventricle Aneurysm

Sciacca¹,

Raffa²,

Gentile

et al. 2016

Med Princ Pract

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Objective: To underscore how challenging the treatment of a coronary artery aneurysm (CAA) can be and highlight the need for consensus guidelines based on focused registries. Clinical Presentation and Intervention: A 58-year-old man presented with acute coronary syndrome and underwent elective stent placement on a right CAA. The procedure was complicated by inferior acute myocardial infarction; 8 months later, due to remodeling toward a left ventricular aneurysm of the inferior wall, he experienced several episodes of sustained ventricular tachycardia that required urgent surgical treatment. Conclusion: The best therapeutic option for CAA is still a matter of controversy, and though the percutaneous approach can meet the technical challenges, ‘heart team'-based decision-making is recommended. The case reported here showed that percutaneous treatment of CAA can be a challenging procedure, even in experienced and high-volume centers. In our patient's case, undersizing the covered stent led to further migration and to a complication that was more severe than the original disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

From Small Coronary Artery Aneurysm to Giant Left Ventricle Aneurysm

Sciacca¹,

Raffa²,

Gentile

et al. 2016

Med Princ Pract

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“…This device did not confer immediate sealing, yet we expected the interposition of the MicroNet between the aneurysm and the lumen to cause stagnant flow, cavity thrombosis, and, after a time, complete obliteration. Delayed sealing should not be a concern, because progression of the aneurysm is usually slow, 1 and there is the additional option of coil embolization with a microcatheter (through the stent meshes), should the open cavity persist.…”

Section: Discussionmentioning

confidence: 99%

“…T he development of coronary artery aneurysms is unpredictable: quiescence, progressive enlargement, 1 thrombus formation, embolism, 2 and sudden rupture 3 are among the possibilities.…”

mentioning

confidence: 99%

Percutaneous Management of a Coronary Bifurcation Aneurysm with Mesh-Covered Stents and the Simultaneous Kissing Stent Technique

Bartolini¹,

Bellotti²,

Iannone³

et al. 2015

Texas Heart Institute Journal

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A 63-year-old man was admitted with a clinical diagnosis of acute coronary syndrome (non-ST-segment Case ReportIn 2013, a 63-year-old man, with hypertension and dyslipidemia, was admitted under a clinical diagnosis of acute coronary syndrome (non-ST-segment elevation), characterized by regional hypokinesia of the left ventricular posterior and lateral walls and by positive cardiac biomarkers. The coronary angiogram showed a large aneurysm with a mural thrombus at the bifurcation of a dominant left circumflex coronary artery (LCx) and a sizable 2nd marginal branch (OM2) (Fig. 1). Intravascular ultrasonography (IVUS) confirmed the presence of a true aneurysm: maximum diameter, 12.5 mm; total length (with transitions), 39 mm; proximal reference diameter, 5.5 mm; and distal reference diameters, 4 mm in the LCx and 4.5 in the OM2.The patient's clinical presentation with an apparent acute coronary syndrome, his negative history for Kawasaki disease (or other forms of arteritis), and the 3-layered wall pattern upon IVUS imaging, led us to speculate that the most likely pathogenesis was atherosclerotic positive remodeling with thromboembolism. A moderate hazy lesion in the proximal OM2, possibly a remnant of a stratified thrombus (Fig. 1), was supportive of that hypothesis. After discussion of the case with other members of the cardiovascular team, we excluded medical management with a vitamin K antagonist or antiplatelet agents. Because the progression and clinical consequences of a large aneurysm are unpredictable and potentially catastrophic, we instead chose percutaneous management with 2 mesh-covered stents.At the time of the intervention, the patient was already on double antiplatelet therapy (clopidogrel 75 mg and aspirin 100 mg orally). After inserting the sheaths, we administered unfractionated heparin (100 IU/kg). Two 6F extra-backup guiding catheters were then advanced through the right femoral artery and the right radial artery. After wiring both branches, we advanced-to the bifurcation-2 polyethylene terephthalate (PET) MicroNet-covered MGuard 39 × 3.5-mm stents (InspireMD,

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Mycotic coronary aneurysms

Buono

Maloberti

Bossi³

et al. 2019

Journal of Cardiovascular Medicine

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Mycotic coronary aneurysm is a rare infective disease of arterial vessel walls. Their development could be linked to the presence of an infective endocarditis or could represent a primary infection at the site of an implanted intracoronary stent. Bacterial agents, particularly Staphylococcus aureus, are the most common etiological agents. Due to an aspecific clinical presentation and examination, diagnosis could be challenging. Multiple imaging techniques (both invasive and noninvasive) are often required to reach the final diagnosis. Prognosis is characterized by high morbidity and mortality rates and, in fact, a tempestive treatment is required, although, to date, scanty data concerning the optimal treatment choice are present in literature.

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Sequential coronary angiograms unveil the progression of an acquired coronary aneurysm

Cited by 3 publications

References 0 publications

From Small Coronary Artery Aneurysm to Giant Left Ventricle Aneurysm

From Small Coronary Artery Aneurysm to Giant Left Ventricle Aneurysm

Percutaneous Management of a Coronary Bifurcation Aneurysm with Mesh-Covered Stents and the Simultaneous Kissing Stent Technique

Mycotic coronary aneurysms

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