Surgical treatment for coronary artery aneurysm: a single-centre experience

Singh, Sushil Kumar; Goyal, Tushar; Sethi, Rishi; Chandra, Sharad; Devenraj, Vijayant; Rajput, Nitin; Kaushal, Dinesh; Tewarson, Vivek; Gupta, Santosh Kumar; Kumar, Sarvesh

doi:10.1093/icvts/ivt282

Cited by 49 publications

(30 citation statements)

References 25 publications

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“…Our data suggest that CS implantation in patients with CAA has acceptable outcomes without thrombotic event. Although a surgical approach may be the most reliable treatment of CAA, percutaneous approaches should be considered for those at high risk or deemed inoperable. In case where CAA gradually enlarges, patients have ischemic manifestations, or patients experience acute MI with the culprit involving CAA .…”

Section: Discussionmentioning

confidence: 99%

Long‐term follow‐up of covered stent implantation for various coronary artery diseases

Hachinohe

Latib

Laricchia

et al. 2019

Cathet Cardio Intervent

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Objectives The aims of this study were to evaluate the long‐term clinical outcomes after coronary covered stent (CS) implantation and to compare the results according to the indications. Background To date, data on the long‐term follow‐up of coronary CS are limited, and no studies have been conducted to compare outcomes on the basis of specific lesions treated. Methods A total of 190 consecutive patients (212 lesions) implanted with CS and surviving until discharge between May 1997 and February 2017 were enrolled in this retrospective study. Clinical outcomes were evaluated and compared using the Gehan–Breslow–Wilcoxon test. Results CS was mainly used for the treatment of a saphenous vein graft (SVG) (51.4%), followed by coronary artery perforation (CAP) (25.0%) and coronary artery aneurysm (CAA) (11.8%). The median follow‐up duration was 6.0 (interquartile range: 1.6–13.5) years. Target vessel myocardial infarction (MI), target vessel occlusion, target lesion revascularization, and stent thrombosis, frequently occurred in the early follow‐up period (7.3%, 16.6%, 21.5%, and 8.9% at 1 year, respectively) and continued to increase throughout the long‐term follow‐up (14.8%, 38.6%, 38.7%, and 17.8% at 10 years, respectively). Target vessel occlusion, target vessel MI, and ST were not identified in CAA with superiority to CAP (Gehan–Breslow–Wilcoxon p‐value = 0.010, 0.047, and 0.046, respectively). SVG had a higher rate of target vessel occlusion than CAA (p = 0.004). Conclusions Clinical events after CS implantation frequently occurred in the early period and steadily increased in the long‐term period. CS implantation in CAA was associated with fewer adverse cardiac events and may lead to safe and acceptable outcomes. However, CS implanted in CAP and SVG are associated with a high risk of long‐term cardiac events.

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Section: Discussionmentioning

confidence: 99%

Long‐term follow‐up of covered stent implantation for various coronary artery diseases

Hachinohe

Latib

Laricchia

et al. 2019

Cathet Cardio Intervent

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“…Surgical approaches, percutaneous covered-stent implantation, coil embolization, and medications, such as antiplatelet and anticoagulant therapy, are used. 6,22,23) However, there are no guidelines for the management of CAAs. Herein, we discuss the management of CAAs by reviewing published reports on CAA with SF, as observed in our patient.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Aneurysm Caused by a Stent Fracture

et al. 2018

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SummaryCoronary stent fracture (SF) is rare as a complication of percutaneous coronary intervention (PCI), and its adverse events are increasingly being recognized with the development in devices of PCI. The major adverse events caused by SFs are in-stent restenosis due to neointimal overgrowth caused by poor drug delivery.1,2) A coronary artery aneurysm (CAA) is a rare complication of SF, but may lead to lethal events such as acute coronary syndrome or rupture of the CAA further leading to cardiac tamponade. [3][4][5] However, the management of CAAs is controversial with or without SF.6) Herein, we report a case of a CAA caused by an SF and discuss the management of CAA complicated with SF, along with a literature review. We suggest that surgical treatment should be considered the higher-priority strategy in the cases of CAA with SF as compared to CAA without SF.(Int Heart J 2018; 59: 203-208) Key words: Coronary artery disease, Drug-eluting stent, In-stent restenosis A lthough the use of drug-eluting stents (DESs) has significantly improved its long-term outcomes after percutaneous coronary intervention (PCI), instent restenosis (ISR) still occurs in some cases and target vascular revascularization is required. 7,8) Coronary stent fracture (SF) is increasingly being recognized as one of the causes of ISR.1) SF can be classified into several types, and complete and severe fracture types rarely lead to coronary artery aneurysm (CAA).9,10) Thus far, the established treatment and management for CAAs with SF are unclear. Case ReportA 69-year-old man with multiple coronary risk factors, including hypertension, hyperlipidemia, type-2 diabetes mellitus, smoking history, and chronic kidney disease, presented to our hospital for a follow-up coronary angiography (CAG) 6 months after PCI. He had undergone CAG and PCI several times as described below.In 2003, an electrocardiogram showed ST segment depression, and a cardiac exercise stress test and radioisotope revealed ischemic changes in the anterior and inferior segments of the left ventricle; therefore, CAG was performed for the first time. CAG demonstrated 90% stenosis in the proximal right coronary artery (RCA) and 75% stenosis in the proximal left anterior descending artery (LAD) with mild stenosis in the left circumflex artery (LCX). PCI was successfully performed, and bare-metal stents (BMSs; 4.0 × 13 mm and 3.5 × 20 mm) were implanted in the ostium of the RCA and proximal LAD, respectively. Six months later, in 2004, a follow-up CAG revealed no in-stent restenosis (ISR), and dual antiplatelet therapy (DAPT) was changed to single antiplatelet therapy (SAPT). In 2014, the patient was diagnosed with earlystage gastric cancer, and CAG was performed before the gastric cancer surgery. CAG revealed ISR in the RCA and progression of the stenosis in the LCX. A week before the surgery, SAPT was changed to heparin, and DAPT was started after it. Following the surgery, PCI was performed and a zotarolimus-eluting stent (Resolute Integlity 2.5 × 22 mm) was implanted in the LCX,...

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“…4 Surgical techniques vary but involve aneurysm resection, ligation, or marsupilization followed by the interposition of graft vessels. 12,13 In regard to our patient, tourniquets were placed in the proximal aspect of the aneurysmal vessels to stop the blood flow followed by graft anastomosis. Patients with higher perioperative risk may be managed with a percutaneous approach.…”

Section: Discussionmentioning

confidence: 99%

Urgent Coronary Artery Bypass Grafting Due to Multi- Vessel Coronary Aneurysm

Aqtash¹,

Amro²,

Alam³

et al. 2018

MJM

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1. Cohen P, O'Gara PT. Coronary artery aneurysms: a review of the natural history, pathophysiology, and management. Cardiol Rev. 2008;16(6) 1. Marshall University, Huntington, West Virginia 2. An-najah National University, Nablus, West Bank, Palestine:The authors have no financial disclosures to declare and no conflicts of interest to report. AbstractCoronary artery aneurysm (CAA) is defined as a dilation of more than 1.5 times normal in a segment of the coronary artery. The incidence of CAA is highest in the right coronary artery (RCA); left main coronary artery or three-vessel involvement is extremely rare. Wide ranges of factors have been implicated in the cause of CAA; atherosclerosis is the most common at 50%. Congenital CAA occurs in 20-30% of cases followed by connective tissue disease at 10%. Blood stagnation and exposure of the underlying collagen make aneurysms prone to thrombosis, dissection, and vasospasm. Depending on the size, symptoms, and etiology of the aneurysms, a surgical, percutaneous, or medical approach may be used. In this paper, we present a patient who presented to the emergency department (ED) with chest pain due to acute coronary syndrome (ACS) that was found to be due to multi-vessel CAAs. The left main as well as RCA, left anterior descending (LAD) artery and left circumflex artery (LCA) were involved and urgent coronary artery bypass grafting (CABG) was required.

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Surgical treatment for coronary artery aneurysm: a single-centre experience

Cited by 49 publications

References 25 publications

Long‐term follow‐up of covered stent implantation for various coronary artery diseases

Long‐term follow‐up of covered stent implantation for various coronary artery diseases

Coronary Artery Aneurysm Caused by a Stent Fracture

Urgent Coronary Artery Bypass Grafting Due to Multi- Vessel Coronary Aneurysm

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