Late giant coronary aneurysm associated with a fracture of sirolimus eluting stent: A case report

Abstract

A 73-year-old female underwent percutaneous coronary intervention (PCI) because of stable angina. An elective PCI for the RCA lesion was first performed with deploying sirolimus eluting stents (SES). Three weeks later, PCI was also provided in the residual LAD lesion. Eight months later, she presented with new angina. CAG revealed an in-stent restenosis in the mid LAD and a large eccentric saccular coronary aneurysm (17 mm x 9 mm) at the proximal RCA. Intravascular ultrasound (IVUS) showed absence of stent struts around the orifice of aneurysm, which suggested a fracture of SES stent. The entry of coronary aneurysm was finally sealed with a polytetrafluoroethylene-covered stent. This report documented a rare case of late giant coronary artery aneurysm associated with a fracture of SES.

Late Catch-Up Phenomenon Associated with Stent Fracture after Sirolimus-Eluting Stent Implantation: Incidence and Outcome

“…This suggests that a different mechanism may affect the ISR in the fractured SES compared to that in the BMS. Previous studies have reported a higher frequency of ISR associated with SF, ranging from 6.3% to 60.0%, [8][9][10][11][12]14,16,17 and stent thrombosis, 12,23 my-ocardial infarction, 24,25 coronary aneurysm, [26][27][28] and sudden death 29 are also reported as a complications associated with SF. There are various strategies for treatment of ISR associated with SF, including simple redilation with a balloon or cutting balloon, and repeat DES deployment (same or another type); however, no optimal strategy has been established.…”

Stent fracture: Insights on mechanisms, treatments, and outcomes from the food and drug administration manufacturer and user facility device experience database

“…Stent fracture (SF) is an uncommon complication observed following percutaneous coronary intervention (PCI), first reported after a bare‐metal stent implantation in a venous bypass graft in 2002 . The occurrence of SF has been associated with adverse complications such as restenosis, stent thrombosis, aneurysm formation, myocardial infarction, and cardiac death with a SF incidence reported between 0.09 and 8.4% . A recent meta‐analysis of 5,321 patients with 108 SFs reported an incidence of 4.0%, with factors identified predisposing to SF including PCI to the right coronary artery, vessel tortuosity, long stents, balloon overexpansion, and the use of overlapping stents .…”

Coronary Artery Pseudoaneurysm Following Blunt Trauma

“…Coronary artery aneurysms are localized luminal dilatations measuring at least one and a half to two times the diameter of a normal adjacent coronary artery segment 6 . While a coronary artery pseudoaneurysm may occur during and after PCI due to traumatic dissection or perforation of the coronary artery, or by deep resection of the vessel wall during directional atherectomy, in the present case the pseudoaneurysm occurred following chest trauma 7 …”