Unexpected evolution of a non-stenotic lesion in the left main coronary artery of a patient with non–ST-segment elevation myocardial infarction

Abstract

A 72-year-old man was referred to our catheterization laboratory 48 hours after a non-ST-segment elevation myocardial infarction. His medical history included coronary artery disease (CAD) (percutaneous coronary intervention of the right coronary artery and chronic total occlusion of the circumflex artery), atrial fibrillation (AF), and chronic kidney disease. An electrocardiogram showed a pre-existent left bundle-branch block and the patient's maximum cardiac troponin concentration was 8.64 µg/L (upper limit of normal: 0.003 µg/L). The coronary angiogram revealed an ulcerated plaque of the left main coronary artery (LMCA) and moderate stenosis of the left anterior descending (LAD) coronary artery. A non-interventional approach to treatment was chosen. One month later, a control angiography showed a giant distal aneurysm complicating the lesion; the fractional flow reserve (FFR) value in the LAD was 0.74. The heart team discussed the case and concluded that the aneurysm was inaccessible via surgery. To protect the LAD from possible covered stent thrombosis or restenosis, coronary artery bypass grafting of the LAD was performed prior to percutaneous coronary intervention (PCI). Five days later, we proceeded with percutaneous exclusion of the aneurysm. We combined coil embolization of three Interlock™ two-dimensional detachable coils with stenting of the LMCA, using a PK Papyrus™ covered stent. Effective angiographic exclusion was achieved. The patient was discharged on warfarin, aspirin, and clopidogrel for 1 month, followed by long-term aspirin and oral anticoagulation. A 6-month follow-up angiography demonstrated a completely sealed aneurysm and optical coherence tomography (OCT) confirmed the successful endothelialization of the covered stent.

Could the Novel Oral Anticoagulants Be Used for Coronary Artery Aneurysm?

“…rombosis is one of the main causes of myocardial infarction in CAAs. Ispas et al [11] used aspirin combined with warfarin for the 2 Case Reports in Medicine patients with left main aneurysm stents at long durations. A recent study also suggested a possible advantage of anticoagulation in patients with CAAs and acute coronary syndrome [12].…”

Percutaneous treatment of saphenous vein graft aneurysm: Contemporary procedural considerations

“…There are minimal published data on the use of these devices as outlined in Table 2, with the majority of experience in small case series or case reports of coronary artery perforation 16,18 and coronary artery aneurysm and fistula treatment. 17,[19][20][21] There are no reported cases of the use of these devices in the treatment of saphenous vein graft aneurysm.…”

Effects of atrial fibrillation on complications and prognosis of patients receiving emergency PCI after acute myocardial infarction

“…After coronary heart disease develops into AMI, the mortality rate of patients may be significantly increased if they are complicated with atrial fibrillation. At present, revascularization can be performed effectively via percutaneous coronary intervention (PCI) for AMI patients complicated with atrial fibrillation, ensuring the reperfusion of ischemic myocardium ( 6 ). However, there are few literature studies on the effect of atrial fibrillation (new-onset or complicated previously) on the prognosis of patients receiving PCI after MI.…”