Successful Long-term Patency of a Complicated Coronary Aneurysm at a Prior Coronary Branch Stent Treated with a Stent Graft and Dedicated Bifurcation Stent

• Type of Material: Article
• Authors: Jung-Joon Cha, Korea University; Hyungdon Kook, Korea University; Soon Jun Hong, Korea University; Cheol W Yu, Korea University; Jon Suh, Soonchunhyang University; Habib Samady, Emory University; Do-Sun Lim, Korea University; Tae Hoon Ahn, Korea University
• Language: English
• Date: 2021-06-01
• Publisher: KOREAN SOC CARDIOLOGY
• Publication Version: Final Published Version
• Copyright Statement: © 2021. The Korean Society of Cardiology
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.4070/kcj.2021.0086
• Title of Journal or Parent Work: KOREAN CIRCULATION JOURNAL
• Volume: 51
• Issue: 6
• Start Page: 551
• End Page: 553
• Grant/Funding Information: The authors received no financial support for the research, authorship, and/or publication of this article.
• Keywords: Cardiovascular System & Cardiology; Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

A 56-year-old female was admitted for unstable angina. She had a history of acute myocardial infarction treated with a stent (Cypher 2.5×23 mm) in a diagonal branch (Dx) 5 years ago. As shown in Figure 1, coronary angiography revealed a large thrombotic aneurysmal change at the stent site. There was a true-bifurcation lesion (Medina 0, 1, 1)1) on the left anterior descending artery (LAD) and Dx ostium (Supplementary Videos 1 and 2). Since complicated coronary aneurysms are associated with worse clinical outcomes,2) we decided to treat both the aneurysm and the bifurcation lesions. With a 7-Fr guiding catheter for the left coronary artery, LAD and Dx were crossed with 0.014-inch guidewires. After predilation, intravascular ultrasound was conducted, revealing aneurysmal change from the proximal edge, but not beyond the distal edge, of the stent (Supplementary Video 3). Thus, to cover the aneurysm's entry point, a stent-graft (Graftmaster 2.8×19 mm; Abbott, Abbott Park, IL, USA) was implanted at the proximal portion of the previous stent. Immediate after stent-graft implantation, there was remaining flow to the aneurysm (Supplementary Video 4). However, the aneurysm was completely regressed in a 4-month follow-up computed tomography (Supplementary Video 5). It suggested that covering the aneurysm's entry point strategy could be a promising treatment method for a coronary stent-induced aneurysm. For the true bifurcation, a dedicated bifurcation stent (AXXESS 3.5×11 mm, Biosensors, Singapore) was implanted in the LAD and Dx to avoid carina shifting. The Dx ostium was treated with drug-coated balloon angioplasty. The final angiogram revealed excellent results for the true-bifurcation lesion and the aneurysm (Supplementary Video 6). Two-year and 7-year follow-up angiograms revealed complete regression of aneurysmal change without complications (Supplementary Videos 7 and 8).