Author + information
- Received May 14, 2013
- Accepted July 3, 2013
- Published online April 1, 2014.
- Chi Yuen Chan, MBChB∗ (, )
- Eugene B. Wu, MD and
- Bryan P. Yan, MBBS
- Division of Cardiology, Department of Medicine and Therapeutics, Li Ka Shing Institute of Health and Science, Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- ↵∗Reprint requests and correspondence:
Dr. Chi Yuen Chan, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China.
A 48-year-old man underwent elective percutaneous coronary intervention of a mid–left anterior descending (LAD) artery bifurcation lesion. A dedicated bifurcation self-expanding biolimus-eluting stent (3.0 × 14 mm AXXESS, Biosensors International, Morges, Switzerland) was implanted in the mid-LAD abutting the carina of the LAD and first diagonal (D1) bifurcation. Three balloon-expandable biolimus-eluting stents (Biomatrix, Biosensors) were placed proximal to the previous stent and in the distal main branch and the D1 side branch overlapping the AXXESS stent in a Y-configuration (Fig. 1A). High-pressure post-dilation of the proximal main vessel was performed with a 3.0-mm noncompliant balloon.
The patient underwent a 12-month follow-up coronary angiogram that showed a large coronary aneurysm in the mid-LAD (Fig. 1B). Optical coherence tomography showed significant positive remodeling in the segment covered by the self-expanding stent that peeled away from the overlapping balloon-expandable stents (Fig. 2, Online Video 1). There was evidence of endothelialization of both the inner balloon-expandable stent and the outer peeled-away self-expanding stent (Fig. 2C). As a result, there was late acquired incomplete stent apposition within the overlapping stented segment.
Coronary artery aneurysm after drug-eluting stent implantation is rare. A possible cause is localized hypersensitivity reaction to the antirestenotic drug, polymer, or the stent material (1). The rationale of a dedicated self-expanding bifurcation stent is to provide an anatomically-tailored treatment of the bifurcation with optimal stent apposition and maximum drug coverage (2,3). Four biolimus-eluting stents with the same biodegradable polymer were implanted in our patient, but aneurysmal change only occurred in the segment covered by the self-expanding stent. It is unknown whether the self-expanding force contributed to the positive remodeling and aneurysmal changes. Our case demonstrated that caution should be taken when overlapping self-expanding and balloon-expandable stents. Although stent apposition may be maintained by the self-expanding nature, late acquired stent malapposition may occur in the overlapping segment.
Dr. Wu has received consulting and proctoring fees from Biosensors International. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 14, 2013.
- Accepted July 3, 2013.
- American College of Cardiology Foundation
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