Author + information
- Received March 14, 2016
- Revision received March 31, 2016
- Accepted April 7, 2016
- Published online July 11, 2016.
- Reiko Shiomura, MDa,
- Nobuaki Kobayashi, MD, PhDa,∗ (, )
- Noritake Hata, MD, PhDa and
- Wataru Shimizu, MD, PhDb
- aDivision of Invasive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
- bDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
- ↵∗Reprint requests and correspondence:
Dr. Nobuaki Kobayashi, Division of Intensive Care Unit, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan.
A 73-year-old man with diabetes mellitus, hypertension, chronic renal failure, and prior myocardial infarction was admitted with acute non–ST-segment elevation myocardial infarction. Coronary angiography (CAG) showed severe stenosis at the ostial left main trunk and the proximal left circumflex artery (Figure 1A, Online Video 1). We decided to perform percutaneous coronary intervention using a T-stent technique. Intravascular ultrasound imaging after stenting (XIENCE Xpedition 3.5/18 mm [Abbott Vascular, Santa Clara, California] for the proximal left anterior descending coronary artery to the left main trunk and XIENCE Xpedition 3.0/18 mm for the proximal left circumflex coronary artery) revealed a coronary dissection and intramural hematoma at the distal edge of the left anterior descending coronary artery stent (Figure 1B, Online Video 2). After additional stenting (XIENCE Xpedition 2.5/23 mm) from the distal edge of the left anterior descending coronary artery stent, final CAG revealed optimal luminal dilation without flow limitation (Figure 1C, Online Video 3). Final intravascular ultrasound showed that the dissection was fully covered by the additional stent, without any gaps (Figure 1D, Online Video 4).
Ten days after the procedure, the patient reported severe chest pain. Repeated CAG showed a giant coronary artery aneurysm (12.7 × 14.6 mm; calculated by quantitative CAG) causing a flow limitation at the site of the treated dissection (Figure 1E, Online Video 5). Computed tomography (Figure 1F) revealed a stent gap at the site of the aneurysm. As a result, the patient underwent coronary artery bypass grafting and aneurysm repair (aneurysmorrhaphy).
The possible mechanism responsible for the rapid growth of this giant coronary artery aneurysm was the treated stent edge dissection, and the aneurysm may have caused the early stent fracture.
For supplemental videos, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 14, 2016.
- Revision received March 31, 2016.
- Accepted April 7, 2016.
- American College of Cardiology Foundation