Author + information
- Received February 9, 2017
- Accepted February 23, 2017
- Published online April 26, 2017.
- Alfonso Jurado-Román, MD, PhD∗ (, )
- Fernando Lozano-Ruíz-Poveda, MD,
- María T. López-Lluva, MD and
- Ignacio Sánchez-Pérez, MD
- Interventional Cardiology Department, University General Hospital of Ciudad Real, Ciudad Real, Spain
- ↵∗Address for correspondence:
Dr. Alfonso Jurado-Román, University General Hospital of Ciudad Real, Avenida Obispo Rafael Torija 13005, Ciudad Real, Spain.
A 50-year-old man with an inferior myocardial infarction was admitted after successful fibrinolysis. Coronary angiography showed 2 giant coronary aneurysms in series in the right coronary artery with high thrombus burden (Figure 1A, Online Video 1), a severe ostial lesion, and ecstatic left coronary tree (Figure 1B). Because the patient remained asymptomatic, dual-antiplatelet therapy and heparin were maintained during 1 week when a slight reduction of thrombus was observed (Figure 1C). After 3 more months on dual-antiplatelet therapy and anticoagulation, the thrombus had almost disappeared. Intravascular ultrasound confirmed a vessel ostial diameter of 4 mm and of 6 mm at the adjacent segments to the aneurysms (Figure 1D). We planned to exclude both aneurysms with 2 overlapped 5 × 26 mm PK-Papyrus polyurethane-covered stents (PCS) (Biotronik, Berlin, Germany), post-dilated with a 6-mm noncompliant balloon (Figures 1E and 1F). However, the proximal aneurysm’s proximal edge was not completely sealed (Figure 1G). Because we did not dispose of more PCS with proper dimensions, we programmed a subsequent procedure to implant a third PCS (5 × 15 mm) in the proximal right coronary artery, also post-dilated with a 6-mm noncompliant balloon. Afterward, complete sealing of the proximal aneurysm was achieved, and another zotarolimus-eluting stent (4 × 18 mm) was implanted in the ostial right coronary artery. Optical coherence tomography showed comparative images of PCS implanted 3 months previously (slight neoatherosclerosis without significant restenosis) and the stent most recently implanted (Figure 1H). Indefinite dual-antiplatelet therapy was prescribed. To the best of our knowledge, this is the first description of a successful exclusion of giant coronary aneurysms in series with overlapped PCS.
Optimal management of giant coronary aneurysm remains uncertain (1,2). Some experience exists with covered stents to exclude coronary aneurysms (1,2). However, the majority present difficult deliverability and potential risk for restenosis and thrombosis (1). The PCS has been designed to improve its deliverability and may expand indications of covered stents to treat coronary aneurysms (2). Careful follow-up of long-term potential complications is necessary.
For the supplemental video, 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 February 9, 2017.
- Accepted February 23, 2017.
- 2017 American College of Cardiology Foundation