Coronary Artery Aneurysm after Second-Generation Drug-Eluting Stent Implantation
10.3349/ymj.2019.60.9.824
- Author:
Sung Jin HONG
1
;
Hyoeun KIM
;
Chul Min AHN
;
Jung Sun KIM
;
Byeong Keuk KIM
;
Young Guk KO
;
Bum Kee HONG
;
Donghoon CHOI
;
Yangsoo JANG
;
Myeong Ki HONG
Author Information
1. Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. mkhong61@yuhs.ac
- Publication Type:Original Article
- Keywords:
Coronary artery disease;
drug-eluting stent;
percutaneous coronary intervention
- MeSH:
Aneurysm;
Angiography;
Coronary Artery Disease;
Coronary Vessels;
Drug-Eluting Stents;
Follow-Up Studies;
Humans;
Incidence;
Myocardial Infarction;
Percutaneous Coronary Intervention;
Prognosis;
Stents;
Thrombosis
- From:Yonsei Medical Journal
2019;60(9):824-831
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We evaluated the incidence, predictors, and prognosis of coronary artery aneurysm (CAA) after second-generation drug-eluting stent (DES) implantation. MATERIALS AND METHODS: A total of 976 consecutive patients (1245 lesions) who underwent follow-up angiography after second-generation DES implantation were analyzed. Incidence and predictors of CAA were assessed, and clinical prognosis was compared with 34 cases of CAA after first-generation DES implantation using previous CAA registry data. RESULTS: All 10 cases of CAA (0.80% per lesion) in 10 patients (1.02% per patient) were detected at follow up. Compared to lesions without CAA, those with CAA had greater involvement of the proximal segment (90% vs. 51%, p=0.014), a higher proportion of pre-intervention, a Thrombolysis in Myocardial Infarction score of 0 or 1 flow (80% vs. 16%, p<0.001), more chronic total occlusions (40% vs. 10%, p<0.001), and longer implanted stents (41.9±23.2 mm vs. 28.8±14.8 mm, p=0.006). As for CAA morphology, instances of CAA after second-generation DES were predominantly the single fusiform type (90%), whereas instances of CAA after first-generation DES were multiple saccular (47%) and single saccular (35%) types (p<0.001). Myocardial infarction with stent thrombosis occurred in 5 patients with CAA after first-generation DES (15%), and no adverse events were observed in patients with CAA after second-generation DES over a median follow-up duration of 4.3 years (p=0.047, log-rank). CONCLUSION: Although CAAs after second-generation DES implantation were detected at a similar incidence to that for CAAs after first-generation DES implantation, second-generation DES-related CAAs had different morphologies and more benign clinical outcomes versus first-generation DES-related CAAs.
