Naslov
„Simultaneous left and right coronary artery aneurysms after the zotarolimus eluting stent implantation”

Autori
Krčmar, Tomislav ; Kos, Nikola

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, ostalo, stručni

Skup
Transcatheter Cardiovascular Therapeutics 2017 (TCT 2017)

Mjesto i datum
Denver (CO), Sjedinjene Američke Države, 29.10.2017. - 02.11.2017

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
coronary artery aneurysm, drug eluting stent, zotarolimus, percutaneous coronary intervention, covered stent

Sažetak
70-year-old female was admitted to the Emergency Department with ST acute segment elevation myocardial infarction (STEMI). Urgent coronary angiography was performed. We found proximal sub- occlusion of the left anterior descending (LAD) artery with a significant bifurcation LAD/D1 stenosis and a proximal to mid segment 95% stenosis of the right coronary artery (RCA). A zotarolimus-eluting stent (Endeavor Resoulte, Medtronic, 3.0 x 24 mm) was directly implanted in the LAD and another ZES (Endeavor Resolute, Medtronic, 3.0 x 38 mm) in the RCA. There was no angiographic evidence of dissection or incomplete expansion after the stent placement. The patient was scheduled for the next intervention with the intention to exclude CAA from the circulation using the stent graft Repeated angiography showed further dilatation of both aneurysms. IVUS showed an approximately 8 mm in diameter large aneurysm of LAD and two smaller aneurysms placed more distal, one of which extended to the ostium of the first diagonal branch. A stent graft (Graftmaster 3.5x19 mm) was placed in the LAD and post-dilated with 3.5x12 and 3.75x8mm non- compliant balloons and the CAA was successfully excluded from the circulation. Another intervention was performed to exclude the 8 mm large aneurysm of the RCA using another stent graft (Graftmaster 2.8x26mm post- dilated with 3.0x8mm balloon). The final angiogram showed exclusion of all CAA with no residual stenosis. Five months later patient presented with anterior wall STEMI. Coronary angiography showed thrombotic occlusion of the LAD at the distal portion of the previously implanted stent. Additional bare-metal stent distal to ZES was placed. The angiography also showed large coronary aneurysms (CAA) of LAD at the level of previously implanted stents. The culprit lesion in the LAD was probably a result of thrombus formation within the aneurysm and embolisation to the distal LAD. There were no systemic signs of hypersensitivity such as fever, leukocytosis or eosinophilia. 6 months after stent graft implantation patient presented with unstable angina due to restenosis in previously implanted stent grafts. Restenosis was treated with non-compliant balloons and scoring balloons. Procedure was finished with application of DCB (Sequent Please 3.5x30mm to LAD and 3.0x30mm to RCA). Aneurysms remains excluded from circulation. During 6 month follow-up patient didn’t have symptoms of angina. Prolonged dual antiplatelet therapy with aspirin and ticagrelor was prescribed. There is no consensus regarding on the treatment algorithm but there are several factors which have to be considered when treating CAA (size, expansion history, pathophysiology and symptoms). Therapy options are BMSt or graft stent implantation, coil embolisation and surgical treatment . To our knowledge this is the first report of two simultaneous CAA of LAD and RCA after ZES implantation due to atherosclerotic CAD.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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