Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan.
J Cardiol. 2009 Aug;54(1):115-20. doi: 10.1016/j.jjcc.2008.09.013. Epub 2008 Nov 25.
Both coronary perforation and aneurysms associated with sirolimus-eluting stent (SES) implantations are uncommon complications. We describe an unusual case of a coronary aneurysm associated with a coronary perforation after SES implantation. Although their pathogenesis has not yet been completely elucidated, some technical factors including the use of excessive pressure during the stent deployment, and sirolimus-induced vascular inflammatory reactions and poor healing response at the perforation site may be related to the shape of the aneurismal formation. Fortunately and interestingly, the size of the coronary aneurysm gradually decreased, and finally by 26 months a nearly complete resolution of the aneurysm had taken place. Furthermore, close follow-up by coronary 3-dimensional computed tomography (3DCT) could clearly demonstrate the natural course of this aneurysm. To the best of our knowledge, there have been no reports on the natural course of coronary aneurysm associated with a coronary perforation after SES(s) implantation for more than 2 years using coronary 3DCT as in this present case. The phenomenon of the spontaneous resolution of the coronary aneurysm after SES implantation may have clinical therapeutic implications.
冠状动脉穿孔和与西罗莫司洗脱支架（SES）植入相关的动脉瘤都是罕见的并发症。我们描述了一例 SES 植入后与冠状动脉穿孔相关的冠状动脉瘤的不寻常病例。尽管其发病机制尚未完全阐明，但一些技术因素，包括支架扩张过程中使用过大的压力，以及西罗莫司诱导的血管炎症反应和穿孔部位愈合不良，可能与动脉瘤形成的形态有关。幸运的是，有趣的是，冠状动脉瘤的大小逐渐减小，最终在 26 个月时，动脉瘤几乎完全消失。此外，通过冠状动脉三维计算机断层扫描（3DCT）密切随访可以清楚地显示该动脉瘤的自然病程。据我们所知，在本病例中，使用冠状动脉 3DCT 对 SES 植入后超过 2 年的冠状动脉穿孔相关冠状动脉瘤的自然病程尚无报道。SES 植入后冠状动脉瘤自发消退的现象可能具有临床治疗意义。
