A case report of pseudoaneurysm of coronary artery within a month of percutaneous coronary intervention

Abstract

Background Coronary artery pseudoaneurysms (PSAs) are uncommon and have poorly understood natural history. Unlike true aneurysms, PSAs do not have all the three layers of the vessel in the aneurysmal wall. PSAs are most commonly seen after an overzealous percutaneous coronary intervention (PCI) which causes damage to the vessel wall. They usually develop slowly after PCI and PSAs within a month of a PCI are not so common. PSA may be asymptomatic or present with recurrent angina. Case summary Here, we report a case of symptomatic PSA to right coronary artery (RCA). The patient had a myocardial infarction for which a PCI was performed to deploy a drug eluting stent (DES) in the RCA. The patient had in-stent restenosis (ISR) within a week of PCI for which plain old balloon angioplasty (POBA) was performed. The patient continued to have unstable angina and within a month of POBA was diagnosed as a case of PSA by intravascular ultrasound. A covered stent was deployed which effectively sealed off the PSA and resumed normal blood flow to distal vessel. Patient has been doing well on medication (aspirin75 mg once daily, atorvastatin 80 mg once daily, and P2Y12 platelet inhibitor [Ticagrelor] 90 mg twice daily). Discussion PSA usually tale six to nine months to develop. However, PSAs have been reported within one to two months of PCI. This case also shows that PSAs can occur within a month of PCI. It is possible that over-aggressive and/or high pressure dilatation and/or deep engagement during POBA performed to open up the ISR could have damaged the struts of the DES and compressed it against the vascular wall. The resultant vascular wall injury could have been the cause of early PSA formation in this case. Hence, cardiologists should be vigilant enough to suspect PSA, especially in a patient presenting with angina. The case also shows that covered stents are a viable option to treat early presentations of PSA.

Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia: A case report

“…There are several reports of pseudoaneurysm formation after DES placement in coronary arteries[ 6 - 9 ]. The underlying mechanisms are thought to be vascular injury during percutaneous coronary intervention and prevention or delay of vascular healing by the eluted drug, which may be caused by inhibition of neointimal hyperplasia and induction of hypersensitivity reactions in the coronary artery endothelium[ 9 , 10 ]. Degenerative aneurysm formation is known to occur in the lower extremity region, especially after FP-DES placement[ 5 , 11 - 13 ].…”

“…In a single-center retrospective study, degenerative aneurysm formation with flow was reported in 1.5% (2/130) of the patients after DES placement in the arterial region of the lower extremities[ 5 ]. Conversely, pseudoaneurysm formation after DES placement is rarely reported in the lower-extremity region, although there are several studies on the incidence of pseudoaneurysms after DES placement in the coronary arteries[ 6 - 9 ].…”

Anterior Descending Coronary Artery Pseudoaneurysm in an 85-Year-Old Male Hemodialysis Patient: A Surgical Case Report

“…In catheter interventions, factors such as the type of catheter used, inappropriate placement, malposition of the stent, dissection of the edge of the stent, rapid injection of contrast agent, and simple balloon angioplasty can cause dissection or perforation of the artery and result in pseudoaneurysm [8][9][10]. The frequency of pseudoaneurysms associated with PCI is reported to be 0.3-6%, usually occurring 6-9 months after PCI [11]. Although this patient also had a history of PCI for LAD, because PCI had been performed 9 years earlier, pseudoaneurysm associated with PCI was ruled out.…”