Aneurisma de artéria coronária um ano e cinco meses pós-implante de stent com eluição de sirolimus

Abstract

A 52-year-old man with diagnosis of post-infarction unstable angina. Coronary angiography revealed 90% luminal obstruction in the middle third of the right coronary artery and 90% in the marginal branch of the circumflex artery. After the administration of clopidogrel 300 mg associated with acetylsalicylic acid, the patient underwent the implantation of a sirolimus-eluting stent Randomized studies with the use of drug-eluting stents have demonstrated an inhibition of neointimal hyperplasia in the majority of patients 1,2 . With the increasing use of these stents, information on their long-term effect is extremely important. The presence of a coronary aneurysm one year and five months after the implantation of a sirolimus-eluting stent is of utmost interest due to the lack of previously reported case reports. CASE REPORTThe patient was a 52-year-old male admitted with a history of very intense oppressive precordial pain at rest. He presented risk factors for coronary disease, systemic arterial hypertension and was a smoker; he also used captopril 12.5 mg twice a day. An electrocardiogram and enzyme measurements were carried out and an acute myocardial infarction was diagnosed, with no upper unleveling of the ST segment. During hospital stay, he presented precordial pain and post-infarction angina was diagnosed. At the physical examination he presented arterial pressure of 120/70 mmHg and cardiac frequency of 80 bpm. Cardiopulmonary auscultation was normal.The electrocardiogram showed a sinusal rhythm, with no abnormalities. Thorax X-ray showed a cardiothoracic index of 0.5, elongated aorta and normal pleuropulmonary fields.The patient underwent a coronary angiography by the Sones technique, which disclosed a luminal obstruction of 90% in the middle third of the right coronary artery (RCA) and 90% in the first marginal branch (MG) ( fig. 1) of the circumflex artery (CA). The venticulography showed a slight lower lateral hypocontractility.The patient was medicated with clopidogrel 300 mg and acetylsalicylic acid (AAS) 200 mg on the same day the angiography was carried out, and on the following day, after a pre-dilation with a Wordpass balloon-catheter (Johnson&Johnson-Cordis) 2.0 x 20 mm, he underwent the implantation of a sirolimus-eluting stent (CYPHER; Johnson&Johnson-Cordis) 2.5 x 18 mm in the lesion at the MG branch with success ( fig. 2). The stent was released with a 12 ATM pressure and the right femoral artery (RFA) was the access via used.The use of the Philips System for the quantitative angiographic analysis of the measurements of the left marginal branch disclosed, at the pre-implantation assessment, a reference diameter of 2.50 mm, a percent Case Report Case Report Case Report Case Report Case Report Case Report (CYPHER; Johnson & Johnson -Cordis) 2.5 x 1.8 mm in the lesion located at the left marginal branch. One year and five months after the CYPHER stent implantation, a new angiography showed intrastent coronary aneurysm at the left marginal branch. This case report suggests that the implantation of...