Coronary Artery Aneurysms After Drug-Eluting Stent Implantation

Abstract

Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth. However, several pathological studies have indicated that DES may delay healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. However, the true incidence of coronary aneurysms in an unselected patient population is still largely unknown. This article reviews the published literature on coronary artery aneurysms specifically relating to DES.

Giant coronary artery aneurysm following implantation of Endeavour stent presenting with fever

“…The antiproliferative mechanism of the anticancer drugs were thought to cause impaired healing effect, which ultimately may be counter-productive and lead to the formation of coronary artery aneurysm. 1,4 In present case, the patient had a giant aneurysm, which was probably because of the zotarolimus eluting stent which had prevented proper healing along with an intense local and systemic inflammatory response. The patient presented with fever along with raised hsCRP at the time of the aneurysm formation.…”

“…1 Aneurysms after PCI are more commonly reported after ablative techniques particularly excisional atherectomy, residual dissection and deep arterial wall injury caused by oversized balloons or stents, high-pressure balloon inflations, and laser angioplasty have all been associated. 1,2 Dissection of the coronary artery during the time of balloon angioplasty has long been known as the major factor related to the occurrence of coronary artery aneurysm.…”

“…1 We report a case of giant aneurysm formation following implantation of a zotarolimus DES. This patient presented with systemic inflammatory manifestations along with chest pain, and was discovered to be having a giant aneurysm at the stent implantation site.…”

Three Year Follow-Up of a Vein Patch Repair for a Coronary Artery Saccular Aneurysm of the Left Main Bifurcation

“…Recently, PCI using drug-eluting stents has become one of causes of coronary artery aneurysms. 5) Coronary artery aneurysms are usually asymptomatic. However, some patients have ischemic symptoms such as angina, or even myocardial infarctions.…”

Coronary CT Angiography as an Alternative to Invasive Coronary Angiography

“…The pathogenesis is related to the underlying cause, but a pre-requisite to aneurysm formation is the presence of an abnormal tunica media in the vessel wall that results in enlargement and remodeling of an arterial segment (DiazZamudio et al 2009). Percutaneous intervention, especially with stents, has also been shown to be a cause for the development of aneurysms (Aoki et al 2008). The diagnostic approach to coronary aneurysms depends on the clinical scenario, and coronary CT angiography is a useful adjunct to diagnose, evaluate, and follow up these coronary artery abnormalities.…”