Contrast Staining Outside the Sirolimus-Eluting Stent Leading to Coronary Aneurysm Formation

Abstract

A 69-year-old man with prior myocardial infarction (hypertension; dyslipidemia; smoking; no diabetes; and no history of allergy, autoimmune disease, or vasculitis) underwent sirolimus-eluting stent (SES) implantation (3.0 mm in diameter; 33 mm in length) for chest pain on exertion with chronic total occlusion of the left anterior descending coronary artery (LAD) (Figure 1A through 1C and Video 1). Intravascular ultrasound examination after SES implantation demonstrated well-expanded stent struts without evidence of incomplete stent apposition (ISA) (Figure 1D through 1F). Figure 1. Baseline angiographic and intravascular ultrasound findings. A, Chronic total occlusion of the proximal LAD before percutaneous coronary intervention (arrow); B, collateral flow into the LAD from the right coronary artery (arrow); C, LAD after SES (3.0 mm in diameter; 33 mm in length) implantation (arrows); D through F, intravascular ultrasound images after SES implantation demonstrating well-expanded stent struts without evidence of incomplete stent apposition. Follow-up angiography at 8 months after initial SES implantation demonstrated multifocal contrast staining outside the stent contour with no evidence of angiographic restenosis (Figure 2A and Video 2). Subsequently, at 16 months after stenting, coronary angiography showed that the areas of contrast staining outside the stent contour increased in size (Figure 2B and Video 3). At 23 months after stenting, coronary artery aneurysm (CAA) formation was demonstrated in the midportion of the SES (Figure 2C and Video 4). The first 8-month …