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Angiographic spontaneous pseudo-resolution of a coronary artery aneurysm after implantation of a sirolimus-eluting stent

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The use of drug-eluting stents (DESs) that elute antiproliferative drugs locally during coronary artery interventions has increased in recent years because of their ability to inhibit neointimal proliferation... However, DESs may also affect the normal healing process of the vessel wall after vascular injury and may be associated with coronary artery aneurysm (CAA) formation in rare cases with various clinical presentations, from asymptomatic to sudden death and myocardial infarction resulting from stent thrombosis... For the next 2 years, the angiogram and IVUS were repeated to assess any changes in the CAA... Angiography revealed partial, spontaneous resolution of the CAA compared with the previous examination (Fig. 1C, 1G and 1D, 1H)... However, IVUS demonstrated remarkable findings, in which echogenic tissue had filled in the free space between the stent and EEM at the stented segments where the apparent angiographic improvement of the CAA occurred (Fig. 2C, 2G and 2D, 2H) without significant restoration of maximal EEM or change of stent CSA, with measured values of 45.2 mm and 9.5 mm at the LAD, respectively, compared with earlier examinations... DESs have dramatically reduced the in-stent restenosis rates by suppressing neointimal hyperplasia... The most important finding in the annual IVUS follow-up in our case was the discrepancy between coronary angiography and IVUS findings in terms of pseudo-resolution of the CAA... In this case, angiographic resolution did not result from restoration of the ectatic vessel, but from the filling up of the dead space between the stents and vessel wall with echogenic material... Thus, IVUS still revealed aneurysmal changes around the stented segments despite angiographic improvement of the CAA... Furthermore, these mechanisms may facilitate negative remodeling of the vessel wall and resolution of the CAA... Although we cannot clearly discuss the nature of the echogenic material that replaced the aneurysmal space in this case, we found that apparent angiographic resolution of a CAA does not always guarantee true restoration of the vessel, and filling up of the aneurysmal space with a thrombus or tissue could be an important mechanism of spontaneous pseudo-resolution of a DES-related CAA... In summary, we report the angiographic spontaneous pseudo-resolution of an SES-related CAA without true restoration of the vessel, as revealed by IVUS... Careful, long-term follow-up with high-resolution imaging modalities will be needed to establish the mechanism, course, and treatment of DES-related CAAs.

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Initial (A, E), serial follow-up coronary angiogram in the anteroposterior caudal (B-D), and left-anterior-oblique (F-H) view. One-year follow-up coronary angiogram (B, F; arrow) revealed multiple aneurysms in all segments of the coronary arteries, which were prominent at the left anterior descending, then regressed at the 2-year follow-up (C, G; arrow) and 3-year follow-up (D, H; arrow).
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f1-kjim-2014-340: Initial (A, E), serial follow-up coronary angiogram in the anteroposterior caudal (B-D), and left-anterior-oblique (F-H) view. One-year follow-up coronary angiogram (B, F; arrow) revealed multiple aneurysms in all segments of the coronary arteries, which were prominent at the left anterior descending, then regressed at the 2-year follow-up (C, G; arrow) and 3-year follow-up (D, H; arrow).

Mentions: The procedural result was successful by angiogram (Fig. 1A and 1E), and IVUS (Galaxy 2, Boston Scientific Corp., Marlborough, MA, USA) revealed well-expanded stent struts without malapposition or dissection (Fig. 2A and 2E). The maximal external elastic membrane (EEM) and stent cross-sectional area (CSA) were 14.3 and 9.6 mm2 at the LAD, respectively. Aspirin, clopidogrel and cilostazol were maintained. One year later, follow-up coronary angiography showed multiple, diffuse, and saccular coronary aneurysms throughout the entire stented segments (Fig. 1B and 1F), accompanied with ectatic changes with malapposed stent struts noted by IVUS (Fig. 2B and 2F). The maximal EEM had increased to 45.3 mm2 without significant change of the stent CSA (9.5 mm2) compared with the post-stent IVUS CSA of the LAD at the index procedure.


Angiographic spontaneous pseudo-resolution of a coronary artery aneurysm after implantation of a sirolimus-eluting stent
Initial (A, E), serial follow-up coronary angiogram in the anteroposterior caudal (B-D), and left-anterior-oblique (F-H) view. One-year follow-up coronary angiogram (B, F; arrow) revealed multiple aneurysms in all segments of the coronary arteries, which were prominent at the left anterior descending, then regressed at the 2-year follow-up (C, G; arrow) and 3-year follow-up (D, H; arrow).
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5016274&req=5

f1-kjim-2014-340: Initial (A, E), serial follow-up coronary angiogram in the anteroposterior caudal (B-D), and left-anterior-oblique (F-H) view. One-year follow-up coronary angiogram (B, F; arrow) revealed multiple aneurysms in all segments of the coronary arteries, which were prominent at the left anterior descending, then regressed at the 2-year follow-up (C, G; arrow) and 3-year follow-up (D, H; arrow).
Mentions: The procedural result was successful by angiogram (Fig. 1A and 1E), and IVUS (Galaxy 2, Boston Scientific Corp., Marlborough, MA, USA) revealed well-expanded stent struts without malapposition or dissection (Fig. 2A and 2E). The maximal external elastic membrane (EEM) and stent cross-sectional area (CSA) were 14.3 and 9.6 mm2 at the LAD, respectively. Aspirin, clopidogrel and cilostazol were maintained. One year later, follow-up coronary angiography showed multiple, diffuse, and saccular coronary aneurysms throughout the entire stented segments (Fig. 1B and 1F), accompanied with ectatic changes with malapposed stent struts noted by IVUS (Fig. 2B and 2F). The maximal EEM had increased to 45.3 mm2 without significant change of the stent CSA (9.5 mm2) compared with the post-stent IVUS CSA of the LAD at the index procedure.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The use of drug-eluting stents (DESs) that elute antiproliferative drugs locally during coronary artery interventions has increased in recent years because of their ability to inhibit neointimal proliferation... However, DESs may also affect the normal healing process of the vessel wall after vascular injury and may be associated with coronary artery aneurysm (CAA) formation in rare cases with various clinical presentations, from asymptomatic to sudden death and myocardial infarction resulting from stent thrombosis... For the next 2 years, the angiogram and IVUS were repeated to assess any changes in the CAA... Angiography revealed partial, spontaneous resolution of the CAA compared with the previous examination (Fig. 1C, 1G and 1D, 1H)... However, IVUS demonstrated remarkable findings, in which echogenic tissue had filled in the free space between the stent and EEM at the stented segments where the apparent angiographic improvement of the CAA occurred (Fig. 2C, 2G and 2D, 2H) without significant restoration of maximal EEM or change of stent CSA, with measured values of 45.2 mm and 9.5 mm at the LAD, respectively, compared with earlier examinations... DESs have dramatically reduced the in-stent restenosis rates by suppressing neointimal hyperplasia... The most important finding in the annual IVUS follow-up in our case was the discrepancy between coronary angiography and IVUS findings in terms of pseudo-resolution of the CAA... In this case, angiographic resolution did not result from restoration of the ectatic vessel, but from the filling up of the dead space between the stents and vessel wall with echogenic material... Thus, IVUS still revealed aneurysmal changes around the stented segments despite angiographic improvement of the CAA... Furthermore, these mechanisms may facilitate negative remodeling of the vessel wall and resolution of the CAA... Although we cannot clearly discuss the nature of the echogenic material that replaced the aneurysmal space in this case, we found that apparent angiographic resolution of a CAA does not always guarantee true restoration of the vessel, and filling up of the aneurysmal space with a thrombus or tissue could be an important mechanism of spontaneous pseudo-resolution of a DES-related CAA... In summary, we report the angiographic spontaneous pseudo-resolution of an SES-related CAA without true restoration of the vessel, as revealed by IVUS... Careful, long-term follow-up with high-resolution imaging modalities will be needed to establish the mechanism, course, and treatment of DES-related CAAs.

No MeSH data available.


Related in: MedlinePlus