Treatment Of Coronary Artery Aneurysm Research Articles

TCTAP C-126 Optical Coherence Tomography Guided Covered Stent Treatment of Coronary Artery Aneurysm

TCTAP C-126 Optical Coherence Tomography Guided Covered Stent Treatment of Coronary Artery Aneurysm

Outcomes of Patients Who Undergo Elective Covered Stent Treatment for Coronary Artery Aneurysms

BackgroundCoronary 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. PurposeTo evaluate the current practice and outcomes of elective treatment of coronary artery aneurysms with covered stents. MethodsWe 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. ResultsA 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. ConclusionsThe 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.

The treatment of coronary artery aneurysm with a hybrid approach

Coronary artery aneurysms (CAAs) are rare cases that generally present with ischemic symptoms. Although coronary artery bypass surgery is widely performed in treatment, endovascular procedures have also begun being used in recent years. We describe a patient developing acute myocardial infarction due to CAA at a young age, despite the absence of any risk factor, followed by rapidly growing aneurysm. This patient was treated with a hybrid approach, very rare case in the literature.

Double-layer bare metal stents in the treatment of coronary artery aneurysm: experience and outcomes in nine patients.

Double-layer bare metal stents in the treatment of coronary artery aneurysm: experience and outcomes in nine patients.

Multiple giant coronary artery aneurysms combined with right coronary artery-pulmonary artery fistula: a case report

BackgroundThe combination of multiple giant coronary artery aneurysms (CAAs) and right coronary artery (RCA) to pulmonary artery (PA) fistula is extremely rare and the patients with CAAs may suffer from several fatal complications. We herein describe a 60-year-old female with hemodynamic instability who was diagnosed with multiple giant CAAs combined with RCA-PA fistula.Case presentationThe patient, a 60-year-old female, presented to the emergency room because of progressive exertional chest distress and fatigue. The transthoracic echocardiography (TTE), coronary computed tomography angiography (CTA) and invasive coronary angiography confirmed the existence of multiple giant CAAs and RCA-PA fistula. Laboratory examinations for systemic vasculitis and infectious diseases demonstrated no abnormalities and work-up for childhood and family history were negative. We have performed a successful surgical treatment for this patient. The patient’s restrictive cardiac dysfunction was improved after debriding the advanced thrombi in aneurysm sac and ligating the fistulous vessel between the native RCA and PA. The postoperative pathologic examination of the aneurysmal wall revealed loss of smooth muscle cells in the media with local mucoid degeneration, no chronic inflammation, sclerosis and IgG4 were observed.ConclusionsThe treatment decision-making process should depend upon the patients’ specific situations. Our case suggests the surgical intervention should be accepted as the preferred treatment for giant CAAs with restrictive cardiac dysfunction.

Progress in the research and treatment of coronary artery aneurysm

Progress in the research and treatment of coronary artery aneurysm

Surgical treatment of coronary artery aneurysms.

Coronary artery aneurysms (CAA) are rare. We present our experience with the surgical treatment of patients with CAAs. Between March 2000 and October 2016, 15 patients with CAA underwent surgery. Mean age of patients was 60 ± 16 years and 47% (n = 7) were male. Kawasaki syndrome was present in two (13%) patients and 7% (n = 1) patients had Marfan syndrome. Isolated CAAs were found in 73% (n = 11) and involvement of multiple vessels was present in 27% (n = 4) of patients. Coronary arteries (CA) affected by aneurysms were: 19% (n = 4) left main stem, 33% (n = 7) left anterior descending, 14% (n = 3) left circumflex, and 33% (n = 7) right coronary artery. The majority of patients (93%, n = 14) were operated on pump with a mean cross-clamp time of 51 ± 23 min. 53% (n = 8) of patients received total arterial CA bypass grafting, while the remaining patients (47%, n = 7) received venous ± internal thoracic artery grafts. Resection/ligation of CAA was performed in 27% (n = 4) of patients. In-hospital mortality was 0% (n = 0). Follow-up was complete for 100% of patients and comprised a total of 80 patient-years. During follow-up, only one patient (7%) required re-intervention. Surgical treatment of CAA has good short- and long-term results.

Surgical Treatment of Coronary Artery Aneurysms

Surgical Treatment of Coronary Artery Aneurysms

外科治療を行った冠動脈瘤の4 例

冠動脈瘤は正常冠動脈径の1.5 倍以上の局所的な拡張と定義される．また比較的稀な病態であり，冠動脈造影検査施行例の0.3～4.9％の頻度で報告されている．部位別には右冠動脈に最も多く，左冠動脈前下行枝，左冠動脈回旋枝，左冠動脈主幹部の順に多いとされる．冠動脈瘤の原因は主に動脈硬化性とされ，その他に外傷，川崎病，血管炎，結合組織病，先天性，感染性，医原性があげられる．冠動脈瘤の多くが無症状であり，その自然歴や予後は依然不明であるが，心筋梗塞などの瘤内血栓形成に伴う血栓塞栓合併症および稀ではあるが瘤破裂の危険性が臨床上問題となる．冠動脈瘤の治療に関しては一定のガイドラインは存在しないが，冠動脈瘤の治療目的は血栓塞栓合併症の予防と瘤破裂の予防にある．今回2005 年4 月から2011 年3月までの6 年間に当科で手術を施行した冠動脈瘤4 例の臨床像を検討した．

Treatment of coronary artery aneurysm with a drug-eluting, vein-covered stent

Treatment of coronary artery aneurysm with a drug-eluting, vein-covered stent

Advances in the treatment of coronary artery aneurysms

Catheterization and Cardiovascular InterventionsVolume 77, Issue 7 p. 1042-1044 Coronary Artery Disease Advances in the treatment of coronary artery aneurysms Emmanouil S. Brilakis MD, PhD, FSCAI, Corresponding Author Emmanouil S. Brilakis MD, PhD, FSCAI esbrilakis@yahoo.com Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas Conflict of interest: Dr Brilakis has received speaker honoraria from St. Jude Medical and Terumo; research support from Abbott Vascular and Infraredx; and his spouse is an employee of Medtronic. Dr. Banerjee has served on the Speakers' Bureau for St. Jude Medical Center, Medtronic Corp., and Johnson & Johnson, and has received a research grant from Boston Scientific and the Medicines Company.Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216Search for more papers by this authorSubhash Banerjee MD, FSCAI, Subhash Banerjee MD, FSCAI Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas Conflict of interest: Dr Brilakis has received speaker honoraria from St. Jude Medical and Terumo; research support from Abbott Vascular and Infraredx; and his spouse is an employee of Medtronic. Dr. Banerjee has served on the Speakers' Bureau for St. Jude Medical Center, Medtronic Corp., and Johnson & Johnson, and has received a research grant from Boston Scientific and the Medicines Company.Search for more papers by this author Emmanouil S. Brilakis MD, PhD, FSCAI, Corresponding Author Emmanouil S. Brilakis MD, PhD, FSCAI esbrilakis@yahoo.com Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas Conflict of interest: Dr Brilakis has received speaker honoraria from St. Jude Medical and Terumo; research support from Abbott Vascular and Infraredx; and his spouse is an employee of Medtronic. Dr. Banerjee has served on the Speakers' Bureau for St. Jude Medical Center, Medtronic Corp., and Johnson & Johnson, and has received a research grant from Boston Scientific and the Medicines Company.Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX 75216Search for more papers by this authorSubhash Banerjee MD, FSCAI, Subhash Banerjee MD, FSCAI Department of Cardiovascular Diseases, VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas Conflict of interest: Dr Brilakis has received speaker honoraria from St. Jude Medical and Terumo; research support from Abbott Vascular and Infraredx; and his spouse is an employee of Medtronic. Dr. Banerjee has served on the Speakers' Bureau for St. Jude Medical Center, Medtronic Corp., and Johnson & Johnson, and has received a research grant from Boston Scientific and the Medicines Company.Search for more papers by this author First published: 19 May 2011 https://doi.org/10.1002/ccd.23212Citations: 6 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume77, Issue71 June 2011Pages 1042-1044 SCAI Member Sign in RelatedInformation

Double‐stent method

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug-eluting-stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene-covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double-stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow-up. Both patients have remained asymptomatic during at least 9 months of follow-up. To the best of our knowledge, this is the first case report describing the use of the double-stent method as an alternative to treat CAAs percutaneously.

Surgical treatment of coronary artery aneurysm

Surgical treatment of coronary artery aneurysm

Does Abciximab Promote Coronary Artery Remodeling in Patients With Kawasaki Disease?

Standard therapy, consisting of intravenous immunoglobulin and aspirin, reduces, but does not eliminate, coronary artery aneurysms (CAAs) in patients with Kawasaki disease. Large CAAs can persist or undergo varying degrees of regression. The treatment of large CAAs using abciximab has been associated with short-term regression; however, longer term data are unavailable. We sought to obtain longer term follow-up data regarding the changes in the diameters of large CAAs in patients receiving both abciximab and standard therapy and to compare these changes to those of a similar group receiving standard therapy alone. All patients with Kawasaki disease and large CAAs (diameter >5 mm or Z score >10) treated from 1986 to 2007 were identified and divided into 2 groups. The abciximab group received abciximab plus standard therapy and the no-abciximab group received standard therapy alone. The maximum diameters of the proximal right and left anterior descending CAAs were obtained from echocardiograms. The Z scores were calculated for 3 points: the acute/subacute phase (<8 weeks) and at 1 and 3 to 5 years of follow-up. The patients in the abciximab (n = 11) and no-abciximab (n = 7) groups were similar in age, interval to treatment, gender, and largest CAA Z score at diagnosis (19.6 +/- 6.2 vs 25.8 +/- 9.5, p = 0.11). The change in CAA Z score was similar between the 2 groups at 1 year (p = 0.99). At 3 to 5 years of follow-up, compared to baseline, the abciximab group had a greater decrease in the CAA Z score than did the no-abciximab group (-14.0 +/- 4.0 vs -8.2 +/- 5.9, p = 0.04). In conclusion, abciximab treatment might be associated with vascular remodeling in patients with large CAAs.

Unusual treatment of coronary artery aneurysm

Unusual treatment of coronary artery aneurysm

Coronary artery aneurysms

Coronary artery aneurysms are rare and are diagnosed almost exclusively by angiography. Apart from a particular form of coronary artery sclerosis congenital malformations and various inflammatory diseases are to be considered aetiologically. Different opinions exist as to the clinical relevance and prognosis as well as to the necessary treatment of coronary artery aneurysms. Over the last 7 years we have observed 10 patients with in part grotesque dilatations of the coronary arteries. Based on the history and the other findings coronary sclerosis or/and congenital malformations had to be assumed. Follow-up of up to 6 years permits not an unfavourable prognosis which is more determined by the accompanying stenosing coronary sclerosis. Due to the danger of thromboses prophylaxis with platelet aggregation inhibitors is recommended. In dilated vascular disorders only surgery should be considered as the exception.

AngioJet thrombectomy for the treatment of coronary artery aneurysm after failed thrombolysis in acute myocardial infarction

Acute myocardial infarction (AMI) is caused by thrombus formation over a disrupted plaque occluding an epicardial coronary artery. Mechanical thrombectomy is effective in removing thrombus burden from native vessels and saphenous vein grafts. Here we report a case of an aneurysmatic dilatation of an infarct-related artery (IRA) referred to our Institute for rescue PCI, after failed fibrinolysis, successfully treated with only rheolytic thrombectomy (AngioJet, Possis Medical, Minneapolis, Minnesota, USA) without the need for adjunctive balloon or stent implantation.

AngioJet Thrombectomy for the Treatment of Coronary Artery Aneurysm after Failed Thrombolysis in Acute Myocardial Infarction

AngioJet Thrombectomy for the Treatment of Coronary Artery Aneurysm after Failed Thrombolysis in Acute Myocardial Infarction

Polytetrafluoroethylene Stent Deployment for a Left Anterior Descending Coronary Aneurysm Complicated by Late Acute Anterior Myocardial Infarction

We report the case of a 66-year-old man with a left anterior descending (LAD) coronary artery aneurysm. Cigarette smoking and hepatitis C virus infection were in his clinical history. Coronary angiography performed in 2002 showed a LAD aneurysm, a 50% stenosis of the right coronary artery, and a 30% stenosis of the left main artery (Figure 1, a through c). The ECG in 2002 was normal (Figure 2b i ). In 2002, the patient underwent successful Jomed polytetrafluoroethylene (PTFE)-coated stenting (3.0×20 mm) to cover the aneurysm (Figure 1d). After stenting, the patient was discharged on ticlopidine 250 mg/d for 1 year, aspirin 100 mg/d, metoprolol 25 mg/d, and transdermal nitrates. Figure 1. LAD …

Use of polytetrafluoroethylene-covered stent for treatment of coronary artery aneurysm

Coronary artery aneurysm is an uncommon occurrence, yet it is described more often today than in the past as coronary angiography is now routinely used for diagnosis and treatment of ischemic heart disease. However, there is no therapeutic consensus regarding this finding. We present a case of giant coronary artery aneurysm and review the literature on the use of polytetrafluoroethylene-covered stents as a therapeutic option for this condition. Combined antiaggregant therapy is needed after the procedure. Randomized controlled trials of surgery versus covered stents are necessary to define the best treatment for large coronary artery aneurysms.