Saphenous Vein Graft Aneurysm 10 Years After Paclitaxel-Eluting Stent Implantation

J INVASIVE CARDIOL 2017;29(5):E63.

Key words: saphenous vein graft, aneurysm, paclitaxel-eluting stent

A 69-year-old male with stable angina and prior history of coronary artery bypass graft surgery successfully underwent percutaneous coronary intervention with two paclitaxel-eluting stents (4.0 x 20 mm, 4.0 x 24 mm) for a saphenous vein graft stenosis (Figures 1A, 1B). Follow-up angiogram after 8 months demonstrated no restenosis, but multifocal peristent contrast staining (PSS) (Figure 1C).¹  

After 10 years, the patient was admitted to hospital due to atrial tachycardia and elevation of cardiac biomarkers. As a result, coronary angiography was performed, which demonstrated a saphenous vein graft aneurysm (11.0 x 12.8 mm) within the stented segment (Figure 1D, Video 1). Considering the size and significant expansion over time, two covered stents were implanted to seal the aneurysm.

Coronary artery aneurysms after drug-eluting stent implantation are a rare complication,^2-5 especially when involving saphenous vein grafts. In this case, only small multifocal PSS was observed angiographically at 8 months, but a large aneurysm was found after 10 years. This late complication should be kept in mind when evaluating patients who have received prior drug-eluting stents.

References

1.    Imai M, Kadota K, Goto T, et al. Incidence, risk factors, and clinical sequelae of angiographic peri-stent contrast staining after sirolimus-eluting stent implantation. Circulation. 2011;123:2382-2391.

2.    Alfonso F, Perez-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.

3.    Aoki J, Kirtane A, Leon MB, Dangas G. Coronary artery aneurysms after drug-eluting stent implantation. JACC Cardiovasc Interv. 2008;1:14-21.

4.    Kim U, Seol SH, Kim DI, et al. Clinical outcomes and the risk factors of coronary artery aneurysms that developed after drug-eluting stent implantation. Circ J. 2011;75:861-867.

5.    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 ¹Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; ²Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; and ³Imperial College London, London, United Kingdom.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Latib serves on the advisory board for Medtronic. The remaining authors report no conflicts of interest regarding the content herein.

Manuscript submitted September 23, 2016, provisional acceptance given September 28, 2016, final version accepted October 5, 2016.

Address for correspondence: Antonio Colombo, EMO-GVM Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy. Email: info@emocolumbus.it