Author + information
- Received January 18, 2017
- Revision received February 6, 2017
- Accepted February 9, 2017
- Published online March 29, 2017.
- Nanda Kishore Panigrahi, MD, DMa,∗ (, )
- Jaganadh Raju, DMR, MD, DMa,
- Dibya Kumar Baruah, MD, DMa,
- Metta Srinivas, MDRDb and
- Ravi Kumar Varma, MDb
- aDepartment of Cardiolgy, Apollo Hospital, Visakhapatnam, India
- bDepartment of Radiology, Apollo Hospital, Visakhapatnam, India
- ↵∗Address for correspondence:
Dr. Nanda Kishore Panigrahi, Division of Cardiology, Apollo Hospital, Health City, Arilova, Visakhapatnam, AP, India, Pin530040.
A 64-year-old diabetic, hypertensive, hyperlipidemic woman presented with features of heart failure with ejection fraction of 40% and mild mitral regurgitation. Two years before she experienced inferior and right ventricular ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention for a thrombotic occlusion of the proximal right coronary artery (RCA) with a drug-eluting stent (DES). After pre-dilatation, a 4 × 18 mm everolimus DES (Abbott Vascular, Santa Clara, California) was successfully deployed at 12 atm and was post-dilated with a 4.0 × 15 mm noncompliant balloon at 16 atm (Figures 1A and 1B, Online Videos 1 and 2). Index coronary angiography showed that the stent was displaced outside the lumen of the RCA, which showed preserved antegrade flow (Figures 2A and 2B, Online Videos 3 and 4). Computed tomography coronary angiography confirmed the location of migrated, malaligned stent into an encapsulated, giant (25 × 27 mm) coronary aneurysm, which was thrombosed (Figures 3A and 3B). There was no evidence of pericardial effusion.
Our case illustrates complete extraluminal migration of a DES from the lumen of the RCA. This would have been possible due to development of a type I coronary aneurysm early after stent deployment as a result of arterial injury (1). As the base of the coronary aneurysm was wider than the length of the DES, a freely floating stent before endothelialization might have been displaced into the giant coronary aneurysm, which was thrombosed over a period of time. Subsequently the RCA was spontaneously recanalized and endothelialized or might have maintained antegrade flow due to collateral channels. However, the stent remained excluded from the coronary lumen.
For supplemental videos and their legends, 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 January 18, 2017.
- Revision received February 6, 2017.
- Accepted February 9, 2017.
- 2017 American College of Cardiology Foundation