Author + information
- Received April 28, 2017
- Accepted May 9, 2017
- Published online August 10, 2017.
- Umihiko Kaneko, MDa,∗ (, )
- Yoshifumi Kashima, MDa,
- Makoto Hashimoto, MD, PhDb and
- Tsutomu Fujita, MDa
- aDepartment of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, Sapporo, Japan
- bDepartment of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo, Japan
- ↵∗Address for correspondence:
Dr. Umihiko Kaneko, Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo Heart Center, North 49, East 16, 8-1 Higashi Ward, Sapporo, Hokkaido 007-0849, Japan.
A 35-year-old man with a history of Kawasaki disease underwent urgent percutaneous coronary intervention for total occlusion of the left anterior descending artery. He had been treated with warfarin, aspirin, and ticlopidine since adolescence. Pre-procedural multidetector computed tomography (MDCT) showed a giant coronary aneurysm (30.7 mm × 24.1 mm) in the proximal left anterior descending artery, which was completely occluded (Figure 1A). Baseline angiography (Figure 1B) and intravascular ultrasound examination verified the giant aneurysm and showed a massive thrombus (Figures 1C and 1D). Following deployment of a 4.0 mm × 32 mm bare-metal stent that was post-dilated to 6.0 mm, satisfactory angiographic results were obtained (Figure 1B’). The stent was placed inside the aneurysm (without normal vasculature on intravascular ultrasound) (Figures 1C’ and 1D’). At 4-year follow-up, no additional clinical event had occurred. Notably, MDCT demonstrated progressive coronary aneurysm enlargement reaching 37.0 mm × 29.0 mm (2-year follow-up: 35.3 mm × 26.7 mm), and stent migration in the aneurysm (Figures 1E to 1G). Considering the risk of stent thrombosis and aneurysm rupture, he underwent aneurysmectomy (Figures 1H to 1J) and coronary artery bypass grafting.
This is a unique case of very late stent migration in a progressively enlarging coronary aneurysm from Kawasaki disease. Mechanisms of stent migration include: 1) continued expansion of the giant coronary aneurysm; 2) stent implantation inside the aneurysm with soft thrombus and discontinuation of normal vasculature; and 3) stent position at a vessel hinge point that produces a shearing force. In adult patients with Kawasaki disease, the continued expansion of the coronary aneurysm occurs infrequently (1); stent implantation has been recommended in these cases (2,3). Our case highlights the importance of a long-term follow-up using MDCT in patients with Kawasaki disease after stent implantation because of the potential for progressive coronary aneurysm enlargement and possible stent migration.
Dr. Fujita has served as a consultant for Terumo Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 28, 2017.
- Accepted May 9, 2017.
- 2017 American College of Cardiology Foundation
- Newburger J.W.,
- Takahashi M.,
- Burns J.C.
- Ishii M.,
- Ueno T.,
- Ikeda H.,
- et al.