Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria; Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St Poelten, Austria.
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK; School of Medicine, Keele University, Keele, UK.
Cardiovasc Revasc Med. 2022 Mar;36:91-96. doi: 10.1016/j.carrev.2021.05.018. Epub 2021 May 24.
Coronary artery aneurysms (CAA) are reported in up to 5% of patients undergoing coronary angiography. Treatment of CAAs with covered stents has been reported in several case reports, however there is limited evidence available on the effectiveness and safety of this interventional practice.
To evaluate the current practice and outcomes of elective treatment of coronary artery aneurysms with covered stents.
We conducted a systematic review of published case reports and case series of patients presenting with CAA that have been treated with covered stents in a non-emergency setting.
A total of 63 case reports and 3 case series were included in the final analysis comprising data from 81 patients. The treated CAA was situated in a native coronary artery in 92.6%, and in a saphenous vein graft in 7.4%. Procedural success was achieved in 95.1%. The types of stents used were mainly polytetrafluoroethylene (75.3%) and Papyrus (11.1%). In 11.0% of cases additional abluminal drug eluting stents (DES) and in 6.8% additional adluminal DES were implanted. After a mean follow up of 13.4 months overall major adverse cardiovascular events (MACE), mortality, myocardial infarction, stroke, stent thrombosis and target lesion revascularization were reported in 26.2, 0.0, 7.6, 0.0, 4.6 and 18.5% of cases, respectively.
The use of covered stents for elective treatment of CAA appears to be effective and reasonably safe. Nevertheless, it is associated with higher MACE rate, driven mainly by higher target lesion revascularization. Further studies, particularly in form of randomized trials and controlled registries are warranted to identify patients who might profit the most from this procedure.
冠状动脉瘤（CAA）在接受冠状动脉造影的患者中发生率高达 5%。已有几例报告采用带膜支架治疗 CAA，但关于这种介入治疗的有效性和安全性的证据有限。
评估带膜支架治疗冠状动脉瘤的现行实践和结果。
我们对已发表的病例报告和病例系列进行了系统评价，这些报告和系列纳入了在非紧急情况下采用带膜支架治疗 CAA 的患者。
最终分析共纳入 63 份病例报告和 3 个病例系列，共涉及 81 例患者。治疗的 CAA 位于原生冠状动脉中的占 92.6%，位于大隐静脉移植物中的占 7.4%。手术成功率为 95.1%。使用的支架类型主要是聚四氟乙烯（75.3%）和 Papyrus（11.1%）。11.0%的病例中植入了额外的血管外药物洗脱支架（DES），6.8%的病例中植入了额外的血管内 DES。平均随访 13.4 个月后，总主要不良心血管事件（MACE）、死亡率、心肌梗死、卒中和支架血栓形成的发生率分别为 26.2%、0.0%、7.6%、0.0%、4.6%和 18.5%。
采用带膜支架治疗 CAA 似乎是有效且相对安全的。然而，它与更高的 MACE 发生率相关，主要由更高的靶病变血运重建所致。需要进一步研究，特别是随机试验和对照登记研究，以确定最有可能从该治疗中获益的患者。
