Very Late Stent Migration Within a Giant Coronary Aneurysm in a Patient With Kawasaki Disease

Kashima, Yoshifumi; Hashimoto, Makoto; Fujita, Tsutomu

doi:10.1016/j.jcin.2017.05.016

Cited by 12 publications

(11 citation statements)

References 4 publications

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“…We chose this device due to its advanced covered single‐stent design that has greater flexibility and smaller crossing profile than the Graftmaster stent (Abbot Vascular, Santa Clara, CA), which is made of an ultra‐thin layer of expandable polytetrafluoroethylene placed between two stents using a sandwich technique. As dislodgement of covered stent with consequent coronary thrombosis was reported in case of incomplete anchorage in aneurysmatic segments of the vessel, 1,2 we used a new technique consisting in the placement of two covered stents inside a long metallic EES placed from “nondilated to nondilated” landing segments. Pre‐intervention OCT imaging played a key role to measure precisely the length of the aneurysmatic segment, to identify proximal and distal landing zones, and for choosing the appropriate stent size in order to obtain complete sealing.…”

Section: Discussionmentioning

confidence: 99%

“…The length of the aneurysmatic vessel segment was assessed with OCT automatic longitudinal reconstruction and measured 42.6 mm, which is longer than the maximal length of the available Papyrus covered stent (26 mm), thus requiring implantation of two devices. Our concern was the risk of articulation and dislodgement of the overlapping Papyrus covered stents due to the lack of apposition and anchoring inside the large aneurysmal segment 1,2 . Therefore, we first deployed a long metallic EES (2.5 × 48‐mm, Xience Xpedition; Abbot Vascular, Santa Clara, CA) across the CCA that was anchored to the proximal and distal ends of the aneurysmatic segment.…”

Section: Case Reportmentioning

confidence: 99%

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Progressive growth of coronary aneurysms after bioresorbable vascular scaffold implantation: Successful treatment with OCT‐guided exclusion using covered stents

Fabbiocchi

Calligaris

Bartorelli

2020

Cathet Cardio Intervent

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The development and progressive enlargement over time of multiple saccular coronary artery aneurysms (CAA) after implantation of everolimus‐eluting stent and bioresorbable vascular scaffolds (BVS) have been reported. CAA was successfully excluded by two overlapped covered stents expanded inside a long metallic drug‐eluting stent to avoid dislodgment at the overlap point. Optical coherence tomography (OCT) was repeatedly performed to monitor CAA expansion and to guide treatment through precise measurement of aneurysm length and vessel size at the landing zone. At 10‐month follow‐up, coronary computed tomography angiography showed persistent CAA exclusion. To the best of our knowledge, this is the first report of this technique to exclude a long CCA segment.

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Progressive growth of coronary aneurysms after bioresorbable vascular scaffold implantation: Successful treatment with OCT‐guided exclusion using covered stents

Fabbiocchi

Calligaris

Bartorelli

2020

Cathet Cardio Intervent

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“…Primary stenting in patients with acute coronary syndrome after Kawasaki disease was performed in eight patients between 1997 and 2019 (Table 1). [4][5][6][7][8][9][10] There were six males and two females. The age at the time of the stenting ranged from 19 to 35 years, with a median of 24 years.…”

Section: Primary Stenting In Acute Coronary Syndromementioning

confidence: 99%

“…A 35-year-old man had a new aneurysm formation 2 years after the bare metal stent implantation for the left anterior descending artery with giant coronary aneurysms; however, he was asymptomatic. 5 He underwent an aneurysrectomy and coronary artery bypass grafting 4 years after stenting, due to migration of the stent with a new aneurysm formation. Another 35-year-old man was asymptomatic for 11 years after bare metal stents stenting.…”

Section: Primary Stenting In Acute Coronary Syndromementioning

confidence: 99%

Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

Tsuda

2020

Cardiol Young

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AbstractFifty years have passed since the first report of Kawasaki disease in 1967, and the prevalence of acute coronary syndrome in Kawasaki disease patients with coronary artery lesions exceeding 40 years old has increased. Primary coronary stent implantation is currently an acceptable method in ischaemic coronary heart disease in adults. However, it is unknown whether the stent implantation is effective or not in this population. As the clue to answer this question, I reviewed the references on Kawasaki disease patients who underwent the stent implantations between 1997 and 2019. Thirty-three patients underwent stent implantations for 34 coronary arteries. Adverse effects in the late period were found in 19 (68%) of 28 vessels with follow-up angiograms. There were complete occlusion 9, restenosis 8, and migration 2. A new aneurysm formation was found in 7 (37%) among the 19 vessels, and 6 (86%) of the 7 vessels were drug-eluting stent and 5 were found after the procedure for chronic total occlusion. The adverse effects free-rate at 1 year and 3 years were 57 and 25%, respectively. At present, the usefulness of stent implantation in the long-term results was scarce. Even if primary percutaneous coronary intervention without a stent implantation is performed for acute coronary syndrome, it can be expected to maintain the patency of the culprit lesion for several years. It is better to avoid a stent implantation as long as possible in this population. Knowing the long-term efficacy and complications of stent implantations is important for deciding the procedure.

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“…KD coronary-artery lesions are not always familiar to physicians, and this population is a very small group among ischemic heart-disease cases in adults. Coronary-stent implantations are an accepted procedure in adults; however, there have been reports about stent fractures, new aneurysm formation, and stent malapposition in patients with coronary-artery lesions caused by KD [2,47,48,49,50]. Generally, the results of coronary-stent implantation for arteries with severe coronary calcification complicated by diabetes mellitus are poorer than those of CABG, and the long-term outcome of stent implantation remains unknown for inflammatory coronary obstruction that often occurs with calcification.…”

Section: Pcimentioning

confidence: 99%

Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease

Kitamura

Tsuda

2019

Children

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As an acquired ischemic heart disease in childhood, coronary-artery disease caused by Kawasaki disease (KD) has been known worldwide since the mid-1970s. KD patients who develop coronary-artery obstructive disease often need revascularization some time in their life. Coronary-artery revascularization for KD coronary lesions can be done with the surgical coronary-artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures. However, the characteristics of coronary-arterial lesions caused by KD significantly differ from atherosclerotic coronary disease in adults. Therefore, it is much more difficult to determine the optimal time and selection of a coronary-artery revascularization procedure for KD sequelae. CABG using the internal thoracic artery has been accepted as a very useful and beneficial procedure since the mid-1980s, even in small children. Although the use of PCI in the late period can be effective in some adolescent and adult patients, the small vessel size and severe coronary-artery calcification are often limiting factors for its use in children. Therefore, CABG is a better approach for severe leftanterior descending artery and multiple-vessel disease in children and adolescents with KD coronary sequelae. Good coronary revascularization can improve the long-term outcomes of patients with severe KD complications.

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Very Late Stent Migration Within a Giant Coronary Aneurysm in a Patient With Kawasaki Disease

Cited by 12 publications

References 4 publications

Progressive growth of coronary aneurysms after bioresorbable vascular scaffold implantation: Successful treatment with OCT‐guided exclusion using covered stents

Progressive growth of coronary aneurysms after bioresorbable vascular scaffold implantation: Successful treatment with OCT‐guided exclusion using covered stents

Insights into stent implantation for coronary artery lesions caused by Kawasaki disease

Significance of Coronary Revascularization for Coronary-Artery Obstructive Lesions Due to Kawasaki Disease

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