PDF(Pubmed)
Abstract：
UNASSIGNED: Coronary aneurysms following drug-eluting stent implantation are rare but associated with adverse events.
UNASSIGNED: An 80-year-old male admitted to our hospital with resting chest discomfort. He had undergone percutaneous coronary interventions (PCIs) with first-generation sirolimus-eluting stent (SES) implantation to the right coronary artery (RCA) and left anterior descending artery (LAD) 14 years ago. Coronary angiography revealed coronary aneurysms and stent fractures in the RCA and LAD where SES was implanted. The aneurysm sizes of the RCA and LAD were 7 × 8 and 7 × 10 mm, respectively. Moreover, in-stent restenosis (ISR) with ischaemia were found in the LAD. The patient was at high risk for cardiac surgery and the coronary aneurysms were not suitable for percutaneous interventions. Therefore, we treated only ISR lesions using drug-coated balloons (DCBs) without intervention for coronary aneurysms. Intravascular ultrasound (IVUS) revealed that the first guide wire went outside the malapposed stents. After rewiring using a double-lumen microcatheter with another guide wire, IVUS confirmed the second guide wire passed entirely inside the stents. Then, the ISR lesions were dilated with high-pressure balloons and DCBs. The post-procedural course was uneventful and his symptoms were relieved.
UNASSIGNED: This case demonstrated coronary aneurysms with ISR and stent fractures 14 years after SES implantation. Depending on patient background and lesion morphology, DCB can be one of the treatment options. Intravascular imaging is useful to guide PCI in patients with coronary aneurysms.
UNASSIGNED: An 80-year-old male admitted to our hospital with resting chest discomfort. He had undergone percutaneous coronary interventions (PCIs) with first-generation sirolimus-eluting stent (SES) implantation to the right coronary artery (RCA) and left anterior descending artery (LAD) 14 years ago. Coronary angiography revealed coronary aneurysms and stent fractures in the RCA and LAD where SES was implanted. The aneurysm sizes of the RCA and LAD were 7 × 8 and 7 × 10 mm, respectively. Moreover, in-stent restenosis (ISR) with ischaemia were found in the LAD. The patient was at high risk for cardiac surgery and the coronary aneurysms were not suitable for percutaneous interventions. Therefore, we treated only ISR lesions using drug-coated balloons (DCBs) without intervention for coronary aneurysms. Intravascular ultrasound (IVUS) revealed that the first guide wire went outside the malapposed stents. After rewiring using a double-lumen microcatheter with another guide wire, IVUS confirmed the second guide wire passed entirely inside the stents. Then, the ISR lesions were dilated with high-pressure balloons and DCBs. The post-procedural course was uneventful and his symptoms were relieved.
UNASSIGNED: This case demonstrated coronary aneurysms with ISR and stent fractures 14 years after SES implantation. Depending on patient background and lesion morphology, DCB can be one of the treatment options. Intravascular imaging is useful to guide PCI in patients with coronary aneurysms.
摘要：
■药物洗脱支架植入后的冠状动脉瘤很少见，但与不良事件有关。
■一名80岁男性因胸部静息不适入院。14年前，他接受了经皮冠状动脉介入治疗（PCIs），并在右冠状动脉（RCA）和左前降支（LAD）上植入了第一代西罗莫司洗脱支架（SES）。冠状动脉造影显示植入SES的RCA和LAD中的冠状动脉瘤和支架骨折。RCA和LAD的动脉瘤大小分别为7×8和7×10mm，分别。此外，在LAD中发现了支架内再狭窄（ISR）伴缺血。该患者的心脏手术风险很高，冠状动脉瘤不适合经皮介入治疗。因此,我们仅使用药物涂层球囊(DCBs)治疗ISR病变,未对冠状动脉瘤进行介入治疗.血管内超声（IVUS）显示，第一根导丝超出了贴壁不良的支架。使用双腔微导管和另一根导丝重新布线后，IVUS确认第二导丝完全通过支架内部。然后，ISR病变用高压球囊和DCB扩张.术后过程顺利，症状缓解。
■该病例在SES植入14年后证实了冠状动脉瘤伴ISR和支架骨折。根据患者背景和病变形态,DCB可以是治疗选择之一。血管内成像对指导冠状动脉瘤患者的PCI是有用的。
■一名80岁男性因胸部静息不适入院。14年前，他接受了经皮冠状动脉介入治疗（PCIs），并在右冠状动脉（RCA）和左前降支（LAD）上植入了第一代西罗莫司洗脱支架（SES）。冠状动脉造影显示植入SES的RCA和LAD中的冠状动脉瘤和支架骨折。RCA和LAD的动脉瘤大小分别为7×8和7×10mm，分别。此外，在LAD中发现了支架内再狭窄（ISR）伴缺血。该患者的心脏手术风险很高，冠状动脉瘤不适合经皮介入治疗。因此,我们仅使用药物涂层球囊(DCBs)治疗ISR病变,未对冠状动脉瘤进行介入治疗.血管内超声（IVUS）显示，第一根导丝超出了贴壁不良的支架。使用双腔微导管和另一根导丝重新布线后，IVUS确认第二导丝完全通过支架内部。然后，ISR病变用高压球囊和DCB扩张.术后过程顺利，症状缓解。
■该病例在SES植入14年后证实了冠状动脉瘤伴ISR和支架骨折。根据患者背景和病变形态,DCB可以是治疗选择之一。血管内成像对指导冠状动脉瘤患者的PCI是有用的。
