Treatment of coronary artery aneurysm with a drug-eluting, vein-covered stent
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CASE REPORT
Treatment of coronary artery aneurysm with a drug-eluting, vein-covered stent Osamu Hashimoto • Joji Hosokawa • Yumi Shimura • Yoshihisa Enjoji • Katsuo Kanmatsuse • Masahiro Endo
Received: 17 September 2013 / Accepted: 9 November 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Introduction
Case presentation
A coronary artery aneurysm (CAA) is defined as a localized dilatation of the coronary artery exceeding 1.5 times the diameter of the adjacent section of the coronary artery [1]. The incidence of CAA among patients who have undergone coronary angiography (CAG) varies from 0.3 to 4.9 % [1]. CAA most commonly involves the right coronary artery, followed by the left anterior descending artery (LAD) and the left circumflex coronary arteries [2]. More than 50 % of CAAs are atherosclerotic [3]. The natural history and prognosis of CAA are unknown, but reported complications include thrombosis, rupture, embolism, vasospasm, and myocardial infarction [3, 4]. Treatment strategies have focused on anticoagulant or antiplatelet therapy, surgical resection, and percutaneous interventions. Percutaneous interventions offer a less invasive alternative to surgical treatments, but short- and long-term outcomes remain unknown [5]. We report a case of an elderly patient with a stenotic lesion and CAA resulting from atherosclerotic disease. The CAA was treated successfully with a combination of an autologous vein graft and a drug-eluting stent (DES). After the procedure, follow-up CAG revealed no leakage or restenosis.
A 71-year-old man with a history of previous myocardial infarction (in 1990), hypertension, hyperuricemia, and smoking was admitted to our hospital for examination of nonsustained ventricular tachycardia (NSVT) in July 2006. He had no symptoms of NSVT, but a Holter electrocardiogram (ECG) showed 8 s of NSVT while sleeping. On physical examination, the heart rate was 75 beats/min, and blood pressure was 120/64 mmHg. Cardiac examination revealed normal first and second heart sounds, with no gallops or murmurs. ECG showed sinus rhythm, normal axis, and q wave in I, aVL, V5, and V6 leads. Transthoracic echocardiography showed a decreased ejection fraction (47 %), with akinesis of the posterior wall and hypokinesis of the lateral wall. The patient was scheduled for CAG and electrophysiological study (EPS). CAG showed stenosis of the proximal LAD, total occlusion of the first diagonal branch (D1), a CAA of approximately 6 mm in the proximal segment of the left high lateral branch (HL), and stenosis of the distal segment of the aneurysm (Fig. 1). EPS induced sustained ventricular tachycardia (superior axis, V rate [ 250 bpm). Treatment with amiodarone and implantation of a cardioverter-defibrillator were recommended, but the patient refused implantation. He received 50 mg atenolol, 300 mg dipyridamole, and 100 mg allopurinol. Additionally, treatment with oral amiodarone was initiated. In December 2007, follow-up CAG showed progression of stenosis in the proximal LAD and dila
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