Cardiovascular
Medicine
Fusiform mid-LAD aneurysm due to passive arterial wall dilatation after implantation of a self-expandable stent
Coronary artery aneurysm Optical coherence tomography (OCT) Intravascular ultrasound (IVUS)

Fusiform mid-LAD aneurysm due to passive arterial wall dilatation after implantation of a self-expandable stent

Images in Cardiovascular Medicine
Coronary artery aneurysm Optical coherence tomography (OCT) Intravascular ultrasound (IVUS)
Alessandro Negro
Additional authors
Luigi Biasco, Giovanni Pedrazzini, Marco Moccetti
Issue
2020/02
DOI:
https://doi.org/10.4414/cvm.2020.02106
Cardiovasc Med. 2020;23:w02106
Affiliations
a FMH Internal Medicine, FMH Cardiology, Sementina, Switzerland
b Ciriè and Ivrea Hospitals, ASL TO4, Italy
c Cardiocentro Ticino, Lugano, Switzerland

Published on 20.04.2020

Coronary artery aneurysm formation following percutaneous coronary intervention (PCI) with drug-eluting stents is a known, infrequent complication, causing late acquired strut malapposition, a potential trigger for in-stent thrombosis [1]. First generation durable-polymer sirolimus-eluting stents showed a significant association with coronary evaginations on optical coherence tomography (OCT), probably related to the inflammatory and durable polymer [2].
The Xposition S is a sirolimus-eluting self-apposing coronary stent with a durable polymer that, by passively adapting to variances in vessel diameter, allows for maximal stent apposition.
We herein report the case of a late acquired fusiform aneurysm of the mid-left anterior descending artery (LAD) caused by the passive arterial wall dilatation as a consequence of the implantation of aself-expandable stent.
A 61-year-old patient, with known coronary artery disease, underwent PCI with a self-expandable stent (Stentis XPOSITION S 3.5−4.5 × 27 mm) for an anterior non-ST segment elevation myocardial infarction (NSTEMI) in January 2016. Post-implant OCT showed good apposition of the stent, with a mean vessel diameter of 3.57 mm at the distal edge and 3.67 mm at the proximal edge (fig. 1)
Figure 1
Post-implant optical coherence tomography (January 2016): good apposition of the stent with a mean vessel diameter of 3.57 mm at the distal edge and 3.67 mm at the proximal edge.
Because of recurrent angina, check-up angiography was performed in March 2018. A fusiform aneurysm of the mid-LAD was discovered. Intravascular ultrasound revealed a uniform dilatation of the vessel with a calibre of 6 mm throughout the whole stented segment, with no evidence of late acquired malapposition (fig. 2), confirming angiographic findings.
Figure 2
Intravascular ultrasound (March 2018): evidence of fusiform aneurysm of the mid-left anterior descending artery, with uniform dilatation of the vessel with a calibre of 6 mm throughout the whole stented segment.
This case represents a new, previously undescribed complication after implantation of self-expandable stent, which caused passive arterial wall dilatation.
Alessandro Negro, MD, Medical Village, Via Cantonale 38, CH-6928 Manno, negro.alessandro[at]yahoo.it
1 Alfonso F, Pérez-Vizcayno MJ, Ruiz M, Suárez A, Cazares M, Hernández R, et al.Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings. J Am Coll Cardiol. 2009;53(22):2053–60. doi:. http://dx.doi.org/10.1016/j.jacc.2009.01.069 PubMed
2 Radu MD, Räber L, Kalesan B, Muramatsu T, Kelbæk H, Heo J, et al.Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study. Eur Heart J. 2014;35(12):795–807. doi:. http://dx.doi.org/10.1093/eurheartj/eht344 PubMed

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