Title: Post Percutaneous Transluminal Coronary Angioplasty (PTCA) Coronary Aneurysm- A Case Report
Authors: Dr Sandipta Ray, Dr. Mainak Mukhopadhya
DOI: https://dx.doi.org/10.18535/jmscr/v12i04.10
Abstract
Coronary aneurysm defined angiographically as luminal dilation 50% larger than that of the adjacent reference segment.(1)
Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth. However, several pathological studies have indicated that DES may delay healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials.(2)
However, the true incidence of coronary aneurysms in an unselected patient population is still largely unknown. It can be congenital, or secondary to vasculitis (Kawasaki disease) or after percutaneous coronary intervention. Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth has become standard of care for routine coronary angioplasty. However, several pathological studies have indicated that DES may delay endothelial healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation (3)
Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. However, the true incidence of coronary aneurysm is still largely unknown. Majority of coronary aneurysm are pseudoaneurysm.(4)
Generally they are asymptomatic diagnosed incidentally. Some presents with feature of heart failure, coronary steel phenomenon and very rarely with atypical symptoms like hemoptysis. CT coronary angiogram is better diagnostic tool for anatomical details.
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