Call for CASES

1
Call for CASES
Percutaneous closure of coronary artery aneurysm
long term implication

• Leszek D. Stachaczyk, MD
• Pawel Buszman, MD, FESC, FSCAI
• American Heart of Poland, Ustroñ, Poland
• CCU, Upper-Silesian Center of Cardiology,
  Silesian Medical School, Katowice, Poland

2
Introduction

• Atherosclerosis of coronary artery may result in
  lumen narrowing or anurysm formation.
• Coronary anurysm enhances the risk of local
  thrombosis and/or peripheral embolisation.
• There is no established treatment for large
  coronary aneurysms.

3
Description of the problem
Case report

• Age 47 / male
• Symptoms Unstable Angina.
• Medical History non-Q myocardial infarction in
  1994.
• Risk factors Hypercholesterolaemia, ex-smoker.

4
Description of the problem

• Concomitant treatment of coronary artery stenosis
  and aneurysm.
• Percutaneous closure of left anterior descending
  coronary artery aneurysm with stent graft.

5

• Left anterior descending coronary artery
  aneurysm.

Coronary angiography LCA LM-short, without
narrowing LAD-proximal aneurysm (diam. ca 5-6mm),
critical narrowings in med segment (90 and
75) Cx-50-60 lesion in med segment. RCA
dominant, normal.
LCA RAO 30
6
Intended strategy
Technical data

• Guiding catheter Judkins Left 4, 7F
• Stent graft Jostent 3.0x16mm on balloon 3.5x20mm
  Quantuum
• Predilatation of LAD and placement of a PTFE
  covered stent
• Direct stenting to med Cx

7
Stenting

• Administration of ticlopidine and ASA 2 days
  before procedure
• Routine anticoagulation during procedure.
• Predilatation and stent implantation to LAD
  (3.0 / 16mm Jostent coronary stent graft with 16
  atm)
• Direct stenting to med Cx

8
Acute Result

• TIMI 3 flow after stent implantation
• Non significant residual stenosis
• No complication

9
Long-term sequel

• Acute MI after 6 months (late in-stent
  thrombosis)
• Successful thrombolysis combined with IIb/IIIa
  inhibitor.

10
Summary

• A 47 year old male with unstable angina was
  addmitted to the hospital for interventional
  diagnosis and treatment.
• Coronary angiography showed a LAD eccentric
  aneurysm and double-vessel coronary artery
  disease (LAD, Cx).
• The aneurysm and the lesion in proximal portion
  of LAD were treated with stent graft. The lesion
  more distally was treated with balloon
  angioplasty. Lesion in the Cx was stented.
• Patient left hospital on combined antiplatelet
  therapy with aspirin and ticlopidine ordered for
  3 months.
• After 6 months patient suffered from anterior AMI
  caused by late in-stent thrombosis, which was
  successfully treated with thrombolysis and
  IIb/IIIa inhibitor.

11
Message

• Percutaneous coronary aneurysm closure with
  Jostent Graft is feasible and efficient.
• The use of this stent requires an extended
  course of double antiplatelet therapy.