Challenges and strategies in the management of coronary artery aneurysms

Zhu, Xiaogang; Zhou, Quanzhong; Tong, Shan; Zhou, Yujie

doi:10.1016/j.hjc.2020.09.004

Cited by 16 publications

(23 citation statements)

References 73 publications

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“…The treatment options for CAAs consist of surgical, percutaneous coronary intervention (PCI) (stent angioplasty and coil embolization), and medical approaches. Unfortunately, there are no established guidelines or standardized recommendations for managing coronary artery aneurysms, but the risk factors' control and lifestyle modification need to be added regardless of the presence of obstructive coronary artery disease [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The use of statins is recommended due to their pleiotropic effect, but the antiplatelet or anticoagulation therapy is controversial, and its use must be based on the risk for thrombosis. Historically percutaneous coronary intervention (PCI) is preferred in smaller aneurysms, and surgical intervention is preferred for larger ones when intervention is deemed necessary [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Left Main Coronary Artery Fusiform Aneurysm

Guerra¹,

Neme²,

Victoria³

et al. 2022

Cureus

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Aneurysm of the coronary artery is an uncommon condition that is usually found incidentally. The left coronary aneurysm is the least common. We report the case of a young patient with a history of vasculitis who was found to have a left fusiform coronary aneurysm. This is a 20-year-old female who has a history of polyarteritis nodosa and who came due to shortness of breath associated with chest discomfort. The physical exam was only relevant for multiple joint pains and tenderness. An echocardiogram showed a possible coronary aneurysm that was confirmed on the angio-tomography. The patient was discharged without complications. The left main coronary artery aneurysm is a rare condition and the least common of the coronary aneurysms. There is no established guideline for screening and therapy of these aneurysms, but invasive methods are not a preferred method for follow-up on this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Left Main Coronary Artery Fusiform Aneurysm

Guerra¹,

Neme²,

Victoria³

et al. 2022

Cureus

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“… 7 Detailed evaluation of the severity of calcifications is important to adapt to the right therapeutic strategy before stenting. 6 These structural characteristic details are revealed and quantified only by using intravascular imaging. 6 Rotational atherectomy, a cutting balloon, and a very high pressure non-compliant balloon were used to treat chronic calcified occlusion but could not prevent the delayed formation of false aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“… 6 These structural characteristic details are revealed and quantified only by using intravascular imaging. 6 Rotational atherectomy, a cutting balloon, and a very high pressure non-compliant balloon were used to treat chronic calcified occlusion but could not prevent the delayed formation of false aneurysms. At the time, we did not have alternative techniques for the treatment of resistant lesions, such as coronary lithotripsy or orbital atherectomy.…”

Section: Discussionmentioning

confidence: 99%

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Unusual interventional treatment of a complex calcified coronary artery lesion in a child with Kawasaki disease: a case report

Mézier¹,

Dauphin²,

Motreff³

2022

European Heart Journal - Case Reports

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Background Kawasaki disease (KD) is a medium vessel vasculitis occurring in children, as yet of undetermined aetiology. KD can lead to severe complications such as coronary artery aneurysms, thrombosis, and sudden death. Monitoring of coronary anomalies is an important issue in the early phase of the disease, and their follow-up is based on different imaging methods. The interventional treatment of these coronary anomalies, which is often complex, is a therapeutic challenge. Case summary We are reporting the case of a four-year-old child who presented KD which was complicated by coronary aneurysm of the proximal left anterior descending artery and ectasia of the right coronary artery (RCA). These lesions progressively calcified and resulted at the age of 13 in chronic occlusion of the RCA. After confirmation of myocardial viability and myocardial ischaemia, a complex angioplasty guided by intracoronary imaging was performed using rotational atherectomy, a cutting balloon, and a high pressure balloon. The control coronary angiography performed 1 year later revealed two false aneurysm on the RCA at the angioplasty site, which were successfully treated with a covered stent. Discussion This case report describes the challenges of treating coronary artery abnormalities such as calcified coronary lesions in children with KD. The coronary intervention of these lesions remains complex and may lead to coronary rupture. We highlight the advantage of using intracoronary imaging in the management of these calcified lesions for successful revascularization, and to assess the complications of percutaneous coronary intervention.

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Outcomes of transcatheter closure for coronary artery fistulas with or without aneurysm: A comparative study

Wei,

Pu,

Chan

et al. 2024

Cathet Cardio Intervent

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BackgroundCoronary Artery Fistulas (CAFs) Patients with aneurysm may face severe complications, necessitating prompt treatment. However, data on the outcomes of transcatheter closure in CAFs patients with aneurysm are notably scarce.MethodsThis retrospective study included all consecutive CAFs patients who underwent transcatheter closure at Fuwai Hospital from January 2010 to December 2023. Patients were divided into two groups based on the presence of aneurysm, and baseline characteristics, anatomical features, and transcatheter closure outcomes were further compared.ResultsThe study ultimately included 104 patients, consisting of 56 in the aneurysm group and 48 in the non‐aneurysm group. Patients in the aneurysm group were younger [39.79 (16.35) versus 50.69 (13.31) years, p < 0.001] and more frequently present with heart murmurs (21.43% vs. 6.25%, p = 0.03). Multivariate logistic regression indicated that a larger fistula diameter and the presence of CCFs are independent risk factors for the presence of aneurysm in CAF patients. The procedural success rate (75% vs. 75%, P = 1), fistula recanalization rate (11.11% vs. 16.67%, p = 0.42), and reintervention rate (3.7% vs. 6.25%, p = 0.89) were similar between the aneurysm and non‐aneurysm groups.ConclusionA larger fistula diameters and the presence of coronary‐cameral fistulas are independent risk factors for the occurrence of aneurysms in patients with CAFs. The outcomes of transcatheter closure are comparable for CAFs patients with and without aneurysm, though post‐closure thrombosis within the fistula appears to be more common in patients with aneurysm.

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Challenges and strategies in the management of coronary artery aneurysms

Cited by 16 publications

References 73 publications

Left Main Coronary Artery Fusiform Aneurysm

Left Main Coronary Artery Fusiform Aneurysm

Unusual interventional treatment of a complex calcified coronary artery lesion in a child with Kawasaki disease: a case report

Outcomes of transcatheter closure for coronary artery fistulas with or without aneurysm: A comparative study

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