Coronary rupture and pseudoaneurysm formation after extravascular migration of a paclitaxel eluting stent implanted in t
- PDF / 437,180 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 105 Downloads / 171 Views
itional material online This article includes three additional videos, which are available at dx.doi.org/10.1007/ s00059-012-3673-2 (at SpringerLink under “Supplemental”)
Introduction As the implantation of drug eluting stents (DES) has become one of the most common clinical practices in interventional cardiology, the complications secondary to this procedure appear to have emerged increasingly over the past decade, with many cases of development of new coronary artery pseudoaneurysms after DES implantation being reported [1, 2, 3, 4]. Here we present a case of coil embolization of a coronary pseudoaneurysm which formed after extravascular migration of a DES.
B. Candemir · T. Altin · H. Ede · S. Durdu · O.U. Ozcan · O. Akyurek Cardiology Department, Heart Center, Ankara University, Dikimevi, Ankara
Coronary rupture and pseudoaneurysm formation after extravascular migration of a paclitaxel eluting stent implanted in the left circumflex coronary artery gram which showed thrombotic occlusion of the proximal left circumflex artery connected with an abnormally located pseudoaneurysm (. Fig. 1). The coronary tomography confirmed a 2.75 × 16-mm paclitaxel eluting stent free-floating in the pseudoaneurysm sac (4 × 3 cm), which was in close proximity to the LCX and superolateral basal left ventricle and left atrial appendage (. Fig. 2). Since the patient declined a surgical option, we decided to proceed with coil embolization of the pseudoaneurysm and its distal neck. The left main coronary artery was engaged with a 6-F CLS 3.5 guiding catheter (Boston Scientific, USA) after standard heparinization. After a floppy-tip 0.014” guide-
wire was left in the LAD territory as a precautionary measure, the neck was passed with a long 0.014” floppy guidewire, over which an over-the-wire 2.3-F microcatheter (Rapidtransit microcatheter, Depuy, USA) was introduced and its distal tip was left in the neck of the sac (. Fig. 3). After the floppy guidewire was retrieved, a total of six microcoils (Cashmere Microcoil 10, Depuy, USA) were sequentially introduced through the microcatheter until total obliteration of the pseudoaneurysm was confirmed (. Fig. 4). After an uneventful period of 5 days, his symptoms resolved completely. He was discharged without any complications, and was free of symptoms at 1-month follow-up. The
Case report A 54 year-old man with a history of hypertension, smoking, and diabetes who had presumably experienced an acute inferior myocardial infarction 1 week prior to admission, was referred to our center. His complaints included “pounding with a lifting” sensation on the left side of midsternum, and chest pain accompanied by progressive dyspnea. He had two paclitaxel eluting stents implanted at proximal and distal segments of the left circumflex artery (LCX) 3 months previously in another center. He underwent a coronary angio-
Fig. 1 7 Right caudal angulation showing the pseudoaneurysm. See also Video 1 online Herz 2 · 2013
| 219
e-Herz: Case study
Fig. 2 8 Coronary computerized tomography demonstrating the
Data Loading...
