Treatment for Coronary Aneurysms: Twenty Years of Experience With Covered Stents

Dear Editors:

We read with interest Boyer et al’s article on treating coronary aneurysms in the June 2014 issue of the Journal of Invasive Cardiology.¹ It is now 20 years since we placed the first homemade polytetrafluoroethylene (PTFE) stent in a patient with a coronary aneurysm.² As this article emphasizes, that is one option in patients with coronary aneurysm. Although exclusion of an aneurysm with the PTFE-covered stent is an important indication, sometimes sealing of a severe dissection results in a life-saving therapy.  

When we first deployed the homemade coronary stent, we felt not only was this an appropriate treatment for aneurysm, but we felt we might be able to limit intimal hyperplasia. Of course, when we first treated patients in 1993, drug-eluting stents were not available. We notice in most cases there was evidence of distal plaque or thrombus emboli as evidenced by delayed filling or no reflow in saphenous vein grafts treated, and clearly some sort of embolic protection was felt to be necessary. Further studies confirm that intimal hyperplasia was not reduced, nor were embolic events prevented when commercially available covered stents were studied.^2-5 

However, the covered stent still has indications in some complex cases of coronary artery aneurysms and of course should be on everyone’s shelf for emergencies.   

References

1. Boyer N, Gupta R, Schevchuck A, et al. Coronary artery aneurysms in acute coronary syndrome: case series, review and proposed management strategy. J Invasive Cardiol. 2014;26(6):283-290.
2. Heuser RR, Diethrich EB, Papaoglou C, Reynolds GT. Endoluminal grafting for percutaneous aneurysm exclusion in an aortocoronary saphenous vein graft: the first clinical experience. J Endovasc Surg. 1995;2(1):81-88.
3. Stone GW, Goldberg S, O’Shaughnessy C, et al. 5-year follow-up of polytefluoroethylene-coverd stents compared with bare-metal stents in aortocoronary saphenous vein grafts. The randomized BARRICADE (barrier approach to restenosis: restrict intima to curtail adverse advents) trial. JACC Cardiovasc Interv. 2011;4(3):300-309.
4. Schächinger V, Hamm CW, Münzel T. A randomized trial of polytetrafluoroethylene-membrane covered stents compared with conventional stents in aortocoronary saphenous vein grafts. J Am Coll Cardiol. 2003;42(8):1360-1369.
5. Turco MA, Buchbinder M, Popma J. Pivotal, randomized US study of the Symbiot covered stent system in patients with saphenous vein graft disease: eight-month angiographic and clinical results from the Symbiot III trial. Catheter Cardiovasc Interv. 2006;68(3):379-388.

From St. Luke’s Medical Center, Professor of Medicine, University of Arizona, College of Medicine — Phoenix, Phoenix, Arizona. 

Address for correspondence: Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI, Chief of Cardiology, St. Luke’s Medical Center, Professor of Medicine, University of Arizona, College of Medicine — Phoenix 555 N. 18th Street, Suite 300, Phoenix, AR 85006. Email: rheuser@iasishealthcare.com