Percutaneous coronary intervention of left main pseudoaneurysm with customized covered stents

Dhakam, Sajid; Ahmeed, Hafeez; Jafarani, Asif

doi:10.1002/ccd.22903

Cited by 16 publications

(11 citation statements)

References 8 publications

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“…Exclusion of duplicate results and articles not meeting specified a priori criteria (162 articles) resulted in 111 articles describing 138 cases of P-SCAD [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76], [77], [78], [79], [80], [81], [82], [83], [84], [85], [86], [87], [88], [89], …”

Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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BackgroundPregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes.MethodsCase study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960–85 (twenty cases) reflecting early management of P-SCAD, 1986–2005 (forty-two cases) reflecting recent management, and 2006–16 (seventy-six cases), reflecting contemporary management.ResultsThe only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023).ConclusionThis systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve.

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Section: Methodsmentioning

confidence: 99%

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Paratz

Kao

MacIsaac

et al. 2018

IJC Heart & Vasculature

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“…Dhakam, et al reported that PCI with covered stent was used successfully to treat a coronary artery pseudoaneurysm. 6) In our case, however, PCI was unlikely to be recommended when we took the location of the aneurysm into consideration. The most common surgical technique may involve ligation of an aneurysm and distal bypass, which was described for the treatment of a left main coronary artery aneurysm.…”

Section: Pseudoaneurysm Following Percutaneous Coronary Interventionmentioning

confidence: 68%

Patch Angioplasty for a Left Main Coronary Artery Pseudoaneurysm following Percutaneous Coronary Intervention

Yamashita¹,

Abe²,

Tabayashi³

et al. 2014

J Jpn Coron Assoc

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A coronary artery pseudoaneurysm usually occurs following catheter-based intervention, probably due to traumatic dissection or perforation of a coronary artery resulting in the disruption of the media without blood seepage through the adventitia. 1) Because of rarity of this condition, treatment strategies are not clearly defined. Herein we report a patient who presented with a left main coronary artery pseudoaneurysm. A 56-year-old woman, who had been on hemodialysis for end-stage renal disease due to chronic glomerulonephritis 5 years before, was referred to our hospital because she had a saccular aneurysm in the left main coronary artery. She had percutaneous coronary intervention (PCI) to the diagonal branch using a rotablator at the age of 54 (Fig. 1A, B). The aneurysm was diagnosed with a pseudoaneurysm by intravascular ultrasound (IVUS), the entry of which was located in the left main coronary artery just proximal to its bifurcation ( Fig. 2A, B). Then the pseudoaneurysm was indicated for surgical intervention. Preoperative contrast computed tomography showed the degree of calcification in the left main coronary artery (Fig. 3A, B). After the patient had median sternotomy and systemic heparinization made, she was placed on cardiopulmonary bypass (CPB). Retrograde cold blood cardioplegia was continuously administered for myocardial protection. The pulmonary artery was transected 2 cm proximal to its bifurcation to optimize the exposure. An aneurysm 8 mm in size was found to be located in the left main coronary artery (Fig. 4A, B). The wall of the aneurysm was incised longitudinally from the left main to the proximal left anterior descending coronary artery. The damaged arterial wall was excised and repaired with a saphenous vein patch (12×25 mm) sutured to the firm arterial wall with a 7-0 polypropylene, while the orifice of the circumflex artery was spared.There was no thrombus in the lumen. Pulmonary artery continuity was restored using a 5-0 polypropylene suture. The patient was weaned easily from CPB and her postoperative course was uneventful. The histological study of the damaged arterial wall confirmed the diagnosis of a pseudoaneurysm (Fig. 5). Postoperative contrast computed tomography showed the anastomosis site was acceptable (Fig. 6). She underwent a living renal transplantation one year postoperatively and has been doing well. II. CommentA coronary artery pseudoaneurysm is as rare a complication as a coronary artery perforation in catheter-based intervention. It is diagnosed by IVUS as a "large, thin-walled, narrow-necked, saccular, vascular structure having no normal arterial wall elements and communicating with the real arterial lumen through a rupture in the arterial wall. 1) Using IVUS, Maehara and colleagues studied 77 consecutive patients with native coronary artery aneurysms by angiography. Of these, only 27% were true aneurysms by IVUS and 4% were pseudoaneurysms. The remaining aneurysmal changes were complex plaques in 16% and Patch Angioplasty for a Left Main Coronary Artery Pseudoan...

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“…4 More recently, covered stents have been used to occlude aneurysm and pseudoaneurysm in coronary arteries 14 and vein grafts. 15 Similarly, as a recent alternative to open surgical closure of pseudoaneurysms of the cardiac chambers, there are reports of successful interventional percutaneous techniques of implanting septal occluder devices in atria and ventricles.…”

Section: Treatmentsmentioning

confidence: 99%

Pseudoaneurysms of the Heart

2012

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Percutaneous coronary intervention of left main pseudoaneurysm with customized covered stents

Cited by 16 publications

References 8 publications

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review

Patch Angioplasty for a Left Main Coronary Artery Pseudoaneurysm following Percutaneous Coronary Intervention

Pseudoaneurysms of the Heart

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