Chest Pain Due to Late Huge Coronary Pseudoaneurysm Following Stent Implantation

Abstract

A 50-year-old man was referred to our hospital because of persistent atypical chest pain. His past medical history was remarkable for a non ST elevation myocardial infarction, treated five months previously with PCI on the right coronary artery. Two months later, for chest pain, he underwent coronary angiography that showed a right coronary artery with slight ectasia near the stent. Five months later for the persistence of atypical chest pain he came to our clinic. Chest CT showed a 31.5 mm hematoma of the right coronary artery. Coronary angiography revealed a giant aneurysm, proximal to the stent. In the light of rapid growth of aneurysm, the risk of rupture and symptoms, we decided to treat the aneurysm with covered stents. The patient underwent successful PCI with regression of symptoms.

Endovascular management of giant coronary artery aneurysm

“…6e8 There are case reports of patients with coronary aneurysm presenting with atypical symptoms resulting from irritation of pleura/pericardium. 9 Our patient presented with classical angina hence was taken up directly for diagnostic coronary angiogram. Hence it is prudent to evaluate all patients with chest pain post PTCA as it can be harbinger of more sinister cause.…”

“…Some aneurysms resolve naturally, but others can lead to life-threatening complications like rupture, thrombosis, embolization, myocardial infarction, and even sudden death. 1,6,7,9,10 In view of this all the aneurysms need to be treated urgently. Treatment options vary from aggressive surgical ligation of the aneurysm to percutaneous implantation of a PTFE-covered stent or conservative medical management in small aneurysms with antiplatelets.…”

Delayed Pseudoaneurysm Rupture and Management After Covered Stent Placement for Post Pancreaticoduodenectomy Hemorrhage: A Case Report

“…Before this case, we used to deploy Development of a pseudoaneurysm after stent implantation is rare. It has been described only in the coronary artery and iliac artery (11)(12)(13). However, development of a pseudoaneurysm following a Fluency ® Plus-covered stent placement for post-Whipple operation bleeding has never been reported.…”

Giant Coronary Artery Pseudoaneurysm after Drug-Eluting Stent Implantation

“…A true aneurysm is characte- rized as a segment with a maximal lumen area larger than a proximal reference lumen by at least 50%. On the other hand, a pseudoaneurysm results from the loss of vessel wall integrity and transition from a three-layered wall to an outwardly bulging monolayer [6]. True coronary aneurysm usually occurs due to late acquired stent malapposition, while pseudoaneurysm occurs as a result of traumatic dissection or perforation of a coronary artery or due to stent fracture [6].…”

“…Subsequent angiographic findings and 2D echo images led us to suspect a pseudoaneurysm in our patient. We suggest that all patients Because of the rarity of this clinical phenomenon, there is no standard therapy recommended for pseudoaneurysm [6]. Several therapeutic approaches have been proposed such as conservative therapy (medical management and observation), percutaneous exclusion of the aneurismal lumen, and surgical intervention (placement of another stent, stent grafts, coronary coils, or coronary artery bypass grafting).…”