A Case Report of a Coronary Artery Aneurysm as a Rare Complication of Percutaneous Coronary Intervention

Document Type: Case Report

Authors

1 Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

A 60-year-old man presented with typical chest pain of the New York Heart Association function class III. The patient mentioned a history of stroke, hypertension, hyperlipidemia, and gastrointestinal bleeding. Angiography revealed a total cut in the mid-portion of the left anterior descending (LAD), a total cut in the ostial portion of the second branch of the diagonal branch of the left circumflex artery (LCX) as well as significant segmental stenosis in the mid-portion of the LCX, and also a significant lesion in the mid-portion of the right coronary artery (RCA). He was scheduled for a multivessel percutaneous coronary intervention (PCI).
The LAD was wired with a 0.014-PILOT 150 guidewire, and 2 drug-eluting stents were deployed in the LAD. Six weeks later, the patient experienced chest pain again, despite receiving full medical treatment. The next angiography showed an unexpected pseudoaneurysm, in the mid-portion of the LAD exactly at the site of the stenting performed in the previous PCI. We considered coronary artery bypass grafting given the high possibility of thrombosis in the LAD and the presence of lesions in the RCA and the LCX.
Conclusions
Coronary aneurysms, albeit rare after PCI, can be life-threatening complications. Early diagnosis can be lifesaving. Chest pain after any intervention should flag up complications, especially in the absence of response to medical treatment. Regular follow-ups are the key to the diagnosis of any complications in the golden time for treatment. (Iranian Heart Journal 2020; 21(2): 84-89)

Keywords


1. Anabtawi IN, de Leon JA: Arteriosclerotic aneurysms of the coronary arteries. J Thorac Cardiovasc Surg1974; 68:226 – 228.
2. Baumbach A, Bittl JA, Fleck E, et al. Acute complications of excimer laser coronary angioplasty: a detailed analysis of multicenter results. Coinvestigators of the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) Registries. J Am Coll Cardiol 1994; 23:1305–13.
3. Slota PA, Fischman DL, Savage MP, Rake R, Goldberg S. Frequency and outcome of development of coronary artery aneurysm after intracoronary stent placement and angioplasty. STRESS Trial Investigators. Am J Cardiol 1997;79:1104 – 6.
4. Condado JA, Waksman R, Gurdiel O, et al. Long-term angiographic and clinical outcome after percutaneous transluminal coronary angioplasty and intracoronary radiation therapy in humans. Circulation 1997;96:727–32.
5. Popma JJ, Leon MB, Moses JW, et al. Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries. Circulation 2004;110:3773– 80.
6. Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis 1997;40:77–84.
7. Aoki J, Kirtane A, Leon MB, Dangas G. Coronary artery aneurysms after drug-eluting stent implantation. J Am Coll Cardiol Intv 2008; 1:14–21.
8. IndolfiC, Achille F, Tagliamonte G, Spaccarotella C, Mongiardo A, Ferraro A. Polytetrafluoroethylene stent deployment for a left anterior descending coronary aneurysm complicated by late acute anterior myocardial infarction. Circulation 2005;112:e70–1.
9. Bell MR, Garratt KN, Bresnahan JF, Edwards ED, Holmes DR Jr. Relation of deep arterial resection and coronary artery aneurysms after directional coronary atherectomy. J Am Coll Cardiol 1992;20:1474-81.
10. Sugimura T, Kato H, Inoue O, Takagi J, Fukuda T, Sato N. Long-term consequences of Kawasaki disease: a 10-to 21-year follow-up study of 594 patients. Circulation 1996;94:1379-85.
11. Aoki J, Kirtane A, Leon M, Dangas G. Coronary artery aneurysms after Drug-Eluting stent implantation. JACC cardiovascular intervention 2008; 1: 14-21.
12. Singh S.K. Goyal T, Sethi R, Chandra Sh, Devenraj V, Rajput N.K, Kaushal D, Tewarson V, Gupta S, Kumar S. Surgical
treatment for coronary artery aneurysm: A single-centre experience 2013; 17: 632-637.
13. Bradbury AW, Milne A, Murie JA. Surgical aspects of Behcet’s disease. Br J Surg 1994;81:1712-21.
14. Yamaguchi H, Yamauchi H, Yamada T, Ariyoshi T, Surgical repair of coronary artery aneurysm after percutaneous coronary intervention. Jpn Circ J 2001;65:52-5.