Coronary Artery Aneurysm After Mini-Crush Drug-Eluting Stent Technique in a Chronic Total Occlusion

J INVASIVE CARDIOL 2017;29(7):E81-E82.

Key words: coronary artery aneurysm, complications, drug-eluting stent

A 53-year-old man underwent percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) of the circumflex artery (Figure 1A). A mini-crush stent technique with two drug-eluting stents (DESs) was performed (Figure 1B). Another overlapped DES was implanted proximally, with good final result despite a residual distal type-A dissection (Figure 1C). Six-month follow-up imaging showed a completely sealed distal vessel and a coronary artery aneurysm (CAA) (Figure 1D, arrow) near the site of the overlapped stents (Figure 1E, arrowhead). Optical coherence tomography demonstrated a true, small, fusiform, type-IV CAA with homogeneous, signal-rich luminal surface (Figure 1E). The struts at the CAA had no endothelial coverage (Figure 1E, asterisk). Struts located at the rest of the circumference and immediately proximal to the CAA were well covered (Figure 1F, asterisk). Conservative management and indefinite dual-antiplatelet therapy was decided. At 9 months, the patient remained asymptomatic. CAAs have been rarely described after DES implantation.^1,2 The underlying pathophysiology remains unknown. In our case, several mechanisms could be involved. First, the vessel damage during initial PCI related to aggressive predilation and probable short subintimal wire passage. Second, the increased local drug delivery at the small area of the three overlapped stents, which could impair vessel healing. To the best of our knowledge, this is the first case of CAA affecting a bifurcated CTO treated with a two-stent technique.

References

1.    Alfonso F, Pérez-Vizcayno MJ, Ruiz M, et al. Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings. J Am Coll Cardiol. 2009;53:2053-2060. 

2.    Bavry AA, Chiu JH, Jefferson BK, et al. Development of coronary aneurysm after drug-eluting stent implantation. Ann Intern Med. 2007;146:230-232.

From the Interventional Cardiology Unit. University General Hospital of Ciudad Real, Spain.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted December 15, 2016.

Address for correspondence: Alfonso Jurado-Román, MD, PhD, Avda Obispo Rafael Torija SN, 13005, Ciudad Real, Spain. Email: alfonsojuradoroman@gmail.com