Fang Ching-Chang, Jao Yeun Tarl Fresner Ng
Department of Cardiology and Critical Care Medicine, Tainan Municipal Hospital, Tainan, Taiwan.
Am J Case Rep. 2017 May 17;18:541-548. doi: 10.12659/ajcr.903529.
BACKGROUND Development of a true coronary aneurysm after percutaneous coronary intervention is a rare event, and a coronary aneurysm resulting in acute myocardial infarction is even rarer. Coronary aneurysm formation after bioresorbable vascular scaffold (BVS) implantation, eventually leading to thrombosis, embolization, and myocardial infarction, has never been reported before in the literature. CASE REPORT A 62-year-old man received an elective BVS for a proximal left anterior descending lesion. Two months later, he suffered from a non-ST-segment myocardial infarction. Coronary angiography showed a non-significant distal stent edge restenosis over the left anterior descending artery and a small aneurysm after the first diagonal branch. A XIENCE Xpedition stent was used to cover both lesions and final angiography showed shrinkage of the aneurysm and resolution of the restenosis. CONCLUSIONS Since a consensus or an established treatment guideline for treating coronary aneurysms is currently lacking, each case should be treated with caution and should be guided by the accompanying circumstances presented during the procedure. Although size, rapidity of growth, and the presence of high-risk features are the main determinants of whether to treat the lesion, the inherent risk of restenosis or reocclusion after use of drug-eluting stents and the coronary intervention procedure itself should also be taken into consideration. However, one must not take lightly a small coronary aneurysm when discovered, as the abnormal fluid dynamics inside may result in thrombus formation and embolization. The fundamental technical aspects of stent deployment, such as avoiding overstretching during lesion preparation, use of balloons shorter than the implanted device, and normal-to-normal or healthy "landing zone" of the device, should be followed.
经皮冠状动脉介入治疗后发生真性冠状动脉瘤是一种罕见事件，而导致急性心肌梗死的冠状动脉瘤更为罕见。生物可吸收血管支架（BVS）植入后形成冠状动脉瘤，最终导致血栓形成、栓塞和心肌梗死，此前文献中从未有过报道。病例报告：一名62岁男性因左前降支近端病变接受择期BVS植入。两个月后，他发生了非ST段抬高型心肌梗死。冠状动脉造影显示左前降支远端支架边缘无明显再狭窄，第一对角支后有一个小动脉瘤。使用XIENCE Xpedition支架覆盖两个病变，最终血管造影显示动脉瘤缩小，再狭窄消失。结论：由于目前缺乏治疗冠状动脉瘤的共识或既定治疗指南，每个病例都应谨慎处理，并应以手术过程中出现的伴随情况为指导。虽然大小、生长速度和高危特征的存在是决定是否治疗病变的主要因素，但使用药物洗脱支架后再狭窄或再闭塞的固有风险以及冠状动脉介入手术本身也应予以考虑。然而，发现小冠状动脉瘤时绝不能掉以轻心，因为其内部异常的流体动力学可能导致血栓形成和栓塞。应遵循支架置入的基本技术要点，如在病变准备过程中避免过度扩张、使用比植入装置短的球囊以及装置的正常-to-正常或健康“着陆区”。
