Frequency and Outcome of Development of Coronary Artery Aneurysm After Intracoronary Stent Placement and Angioplasty

Slota, Paul A.; Fischman, David L.; Savage, Michael P.; Rake, Randal; Goldberg, Sheldon

doi:10.1016/s0002-9149(97)00055-6

Cited by 92 publications

(64 citation statements)

References 8 publications

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“…The size of the effect within any particular subgroup can vary from the overall effect. For example, in recent trials focusing on heart failure, 28 -31 coronary intervention, [32][33][34][35] coronary reperfusion, 36 -39 and secondary prevention with statins (Figure 2), 40 the treatment effect across known risk factors was highly consistent in terms of direction and relative size. Any variations were well within the expected range, as compared with other trials with the same number of events.…”

Section: Subgroups and Treatment Interactionsmentioning

confidence: 99%

Lessons Learned From Recent Cardiovascular Clinical Trials: Part I

2002

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T his is the first installment in a 4-part series of articles about our experiences with cardiovascular clinical research during the past 2 decades. From our vantage points as statistical and clinical researchers, we derive a series of lessons from recent clinical trials and incorporate them into principles designed to guide the practicing clinician who cares for patients with heart diseases.We are entering an era in which the imperative to understand the rational basis for diagnostic and therapeutic options has become a major force in medical care. Medical products (drugs, devices, and biologics) are proliferating simultaneously with a substantial restructuring of the delivery of health care, with a focus on evidence to support medical interventions. As the texture of evidence to support clinical practice becomes clearer, the imperative to investigate the effectiveness of behavioral interventions becomes more important. When coupled with concern about the rising cost of medical care, this proliferation of technological and behavioral intervention reinforces the view that we cannot afford to offer all possible diagnostic and therapeutic options to all patients. Recent publicity about therapies that were in widespread use and were later found to be detrimental 1-3 has fueled this concern to extend well beyond the cost implications. The advent of genomics, proteomics, combinatorial chemistry, and advanced biomedical engineering will increase the importance of developing rational evidence about therapeutic risks and benefits. This effort to develop a rational basis for diagnostic and therapeutic decisions on the basis of quantitative assessments is a major component of evidencebased medicine.The randomized clinical trial (RCT) has emerged as the principal research tool for developing evidence to inform and influence clinical practice, particularly in the cardiovascular field. The practice of clinical trials is built on an understanding of the biology of disease, the structure of medical care delivery, statistical design and analysis, data management, clinical research quality, and scientific and medical integrity. As clinical trials continue to evolve, investigators will be challenged to find the optimum balance among these factors that best evaluates new interventions and places older approaches in the proper context as new technology and practice patterns emerge.Because the RCT is relatively new as a scientific technique, little empirical experience could be used to test this balance in the past. However, the recent explosive growth of RCTs with their widely discussed methodological approaches has been valuable in guiding current RCT design and deployment. 4,5 In the first 2 parts of this series of articles, we will review some of the lessons we have learned from recent cardiovascular trials about the conduct of trials. In the second two parts, we will examine proposed implications of these lessons for medical practice and focus on applying the concepts in clinical trials to patient care decisions. These concepts...

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Section: Subgroups and Treatment Interactionsmentioning

confidence: 99%

Lessons Learned From Recent Cardiovascular Clinical Trials: Part I

2002

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“…[25][26][27][28][29] Pseudoaneurysms are the most common form of trauma-induced coronary aneurysms, because of abnormal healing of an intimal dissection that occurs at the time of intervention. True aneurysms involving all 3 layers are uncommon after coronary intervention.…”

Section: Coronary Aneurysmsmentioning

confidence: 99%

Quantitative Assessment of Angiographic Restenosis After Sirolimus-Eluting Stent Implantation in Native Coronary Arteries

et al. 2004

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Background-Sirolimus-eluting stents (SESs) reduce angiographic restenosis in patients with focal, native coronary artery stenoses. This study evaluated the usefulness of SESs in complex native-vessel lesions at high risk for restenosis. Methods and Results-Angiographic follow-up at 240 days was obtained in 701 patients with long (15-to 25-mm) lesions in small-diameter (2.5-to 3.5-mm) native vessels who were randomly assigned to treatment with SESs or bare-metal stents (BMSs) in the SIRIUS trial. Quantitative angiographic measurements of minimal lumen diameter and percent diameter stenosis were obtained within the treated segment, within the stent, and within its 5-mm proximal and distal edges. Patients treated with SESs had lower rates of binary (Ͼ50% diameter stenosis) angiographic restenosis within the segment (8.9% versus 36.3% with the BMS; PϽ0.001) and within the stent (3.2% versus 35.4% with the BMS; PϽ0.001). SESs were associated with significantly less late lumen loss within the treated segment, within the stent, and within its 5-mm proximal and distal edges (all PϽ0.001). The reduction of restenosis with the SES was consistent in patients at risk for restenosis, including those with small vessels, long lesions, and diabetes mellitus. The frequency of late aneurysms was similar in the 2 groups. Conclusions-Compared with BMSs, SESs reduced angiographic late lumen loss within the stent and its adjacent 5-mm margins in patients with complex native-vessel lesions.

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“…Coronary angiography is the gold standard for the diagnosis of coronary aneurysms, which are defined as a luminal dilation 50% larger than that of the adjacent reference segment 3,11,12 . However, coronary angiography provides only luminal information and cannot visualize other structures, including the layers of the arterial wall.…”

Section: Discussionmentioning

confidence: 99%

“…Most "aneurysms" are in fact pseudoaneurysms rather than true aneurysms [1][2][3][4] . Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high pressure balloon inflations, atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention 1-3 .…”

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confidence: 99%

Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report

et al. 2017

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Introduction:Coronary artery aneurysms after coronary intervention are rare, 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. Most "aneurysms" are in fact pseudoaneurysms rather than true aneurysms [1][2][3][4] . Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high pressure balloon inflations, atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention 1-3 . Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis 5,6 , but at the same time potentially causing coronary aneurysms due to other mechanisms, such as delayed reendothelialization, inflammatory changes of the medial wall, and hypersensitivity reactions [7][8][9][10] . These findings may be due to delayed healing secondary to the antiproliferative action of the eluted drug, cell necrosis and/or apoptosis from the antimetabolite effect of the drug, and hypersensitivity reactions to the drug/polymer mixture on the DES 7-9 . Systemic administration of antiinflammatory agents (glucocorticoids and colchicine) after stent implantation may be associated with a greater risk of aneurysm formation. 11 However, the true incidence, clinical course, and treatment of coronary artery aneurysms after DES implantation remain largely unknown.Case Report: Mr. X, 60 years old non smoker, non alcoholic, diabetic, hypertensive businessman got admitted in NICVD with complaint of ischaemic chest pain on minimal exertion for 3 months. ECG was within in normal limit, ETT was positive and Echocardiogram showed Anterior wall hypokinesia with EF-65%. CAG showed Significant long lesion in LAD. Direct stenting to LAD was done at the same setting with Promus Element ( 2.75×38mm, at 18 ATM).Whole procedure was uneventful and patient was discharged from hospital with double antiplatelet coverage. After 10 days of PCI patient got readmitted in hospital with complaints of chest discomfort with high grade fever for 2 days. ECG showed AMI ( Extensive Anterior) indicating involvement of LAD territory with strong suspicion of Sub Acute Stent Thrombosis (SAST). Streptokinase could not be given due to delayed arrival. Patient was treated conservatively with LMWH. Blood and urine culture was negative. Check CAG was done 7 days after readmission showing Patent stent in LAD with aneurysmal dilatation at the distal end of stent in LAD. Drug-Eluting Stent (DES) Induced Coronary

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Frequency and Outcome of Development of Coronary Artery Aneurysm After Intracoronary Stent Placement and Angioplasty

Cited by 92 publications

References 8 publications

Lessons Learned From Recent Cardiovascular Clinical Trials: Part I

Lessons Learned From Recent Cardiovascular Clinical Trials: Part I

Quantitative Assessment of Angiographic Restenosis After Sirolimus-Eluting Stent Implantation in Native Coronary Arteries

Drug-Eluting Stent (DES) Induced Coronary Artery Aneurysm - A Rare Case Report

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