Surgical Repair of Coronary Artery Aneurysm After Percutaneous Coronary Intervention

Abstract

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...

Surgical treatment for coronary artery aneurysm: a single-centre experience

“…Surgical approach is thought to be safer and more reliable for repair of a coronary aneurysm/pseudoaneurysm. The indications for the surgical treatment of CAA in general are (i) severe coronary stenosis, (ii) complications such as fistula formation, (iii) compression of the cardiac chambers, (iv) high likelihood of rupture such as rapidly increasing size of the aneurysm or pseudoaneurysm and (v) any type of aneurysm developing after coronary intervention [23,24].…”

eComment. Coronary artery dilatation: ectasia or aneurysm

“…There have been very few case reports of treatment of CAA with covered stent graft and the technique is still in the evolving phase [22].Surgical approach is thought to be safer and more reliable for repair of a coronary aneurysm/pseudoaneurysm. The indications for the surgical treatment of CAA in general are (i) severe coronary stenosis, (ii) complications such as fistula formation, (iii) compression of the cardiac chambers, (iv) high likelihood of rupture such as rapidly increasing size of the aneurysm or pseudoaneurysm and (v) any type of aneurysm developing after coronary intervention [23,24].Operative therapy may include aneurysm ligation, resection or marsupialization with interposition graft, and the ideal approach has not yet been formally studied [25].In our 3 cases of coronary aneurysm, a common surgical technique was employed which included proximal ligation, plication and revascularization. In 1 case, proximal ligation and revascularization was done.In conclusion, the treatment for coronary artery aneurysm is still controversial.…”

Cardiac computed tomography as a diagnostic tool for coronary artery aneurysm following percutaneous coronary intervention

“…Thus, in view of the symptomatic nature of the patient, surgical repair and revascularization was indicated for the patient. [6] Three-dimensional reconstruction images by CCT helped for treatment plan [ Figure 4]. Plication of the coronary aneurysm and coronary artery bypass grafting were performed through a median sternotomy using cardiopulmonary bypass and hypothermic blood cardioplegia.…”