Korean Circ J.  2008 Apr;38(4):230-234. 10.4070/kcj.2008.38.4.230.

A Case of Huge Coronary Aneurysm After Implantation of a Sirolimus-Eluting Stent

• Seo KW
• Tahk SJ
• Choi SY
• Yoon MH
• Choi BJ
• Lim HS
• Shin JH
• Hwang GS
• Kang SJ
• Kim JW
• Lim NK
• Lee MH

• KMID: 2225826
• DOI: http://doi.org/10.4070/kcj.2008.38.4.230

Abstract

This report describes the case of a 62-year-old woman who was previously diagnosed with stable angina. Coronary angiography revealed clinically significant stenosis in the middle of the left anterior descending (LAD) artery, the first diagonal branch, the distal left circumflex (LCX) artery and the proximal posterior descending artery (PDA). After administering aspirin and clopidogrel, the patient underwent implantation of sirolimus-eluting stents in the middle LAD artery and the first diagonal branch. Bare-metal stents were implanted in the distal LCX artery and the proximal PDA. Nineteen months later, follow-up coronary angiography revealed aneurysmal dilation at the middle LAD artery and the first diagonal branch. Forty-six months after implantation of the sirolimus-eluting stents, the size of the coronary aneurysm had increased to 12.4 mm; however, no sign of aneurysmal dilatation was observed at the bare-metal stent sites. This suggested that the implantation of the sirolimus-eluting stent was partially responsible for causing the coronary aneurysm.

Keyword

Coronary aneurysm; Sirolimus; Drug-eluting stent

MeSH Terms

Aneurysm
Angina, Stable
Arteries
Aspirin
Constriction, Pathologic
Coronary Aneurysm
Coronary Angiography
Dilatation
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Middle Aged
Sirolimus
Stents
Ticlopidine
Aspirin
Sirolimus
Ticlopidine

Figure

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  Fig. 1 Initial coronary angiogram at first admission. A: there were multiple significant stenoses (a) in the middle left anterior descending (LAD) artery, the first diagonal branch, (b) the distal left circumflex (LCX) artery and (c) the proximal posterior descending artery (PDA). B: after intervention, stents were successfully implanted (a and b: anteroposterior cranial view, c: left anterior oblique caudal view).

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  Fig. 2 Serial follow up angiogram in the antero-posterior caudal view. The coronary angiogram revealed progressive dilatation of the aneurysms at both the middle left anterior descending (LAD) and the first diagonal branch stent lesions. A: 6 months follow-up. B: 19 months later. C: 24 months later. D: 46 months later.

• 

  Fig. 3 Coronary angiogram and left anterior descending (LAD) intravascular ultrasound (IVUS) findings after 46 months. The maximal aneurysm diameter was 12.4 mm. The star marks the area malapposed behind stent within the vessel. The area was 17.6 mm2. A: proximal reference. B: proximal part of the stent. C: within the stent at the bifurcation site. D: distal part of the stent. E: distal reference.

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  Fig. 4 Serial comparison of the intravascular ultrasound (IVUS) findings. Each row is composed of findings from the proximal reference, within the stent at the bifurcation site and the distal reference, respectively. A: after initial intervention. B: 19 months later. C: 46 months later.

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