Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings.
OBJECTIVE
This study sought to assess clinical, angiographic, and intravascular ultrasound (IVUS) findings in patients developing coronary aneurysms (CANs) after drug-eluting stent (DES) implantation.


BACKGROUND
The long-term safety of DES remains unsettled.


METHODS
This study analyzed 1,197 consecutive patients with late angiographic evaluation after DES implantation. In 15 patients (1.25%, 95% confidence interval: 0.58 to 1.93), CANs developed at follow-up. Analyses included quantitative angiography and volumetric IVUS.


RESULTS
DES developing CANs were more frequently implanted during acute myocardial infarction and were longer than those without this outcome. The elapsed time from DES implantation to CAN diagnosis was 313 +/- 194 days. Angiographically, maximal CAN diameter measured 5.1 +/- 1.2 mm. On IVUS, CAN external elastic lamina area was 32 +/- 13.1 mm(2) and incomplete apposition area was 12.1 +/- 8.6 mm(2). Two patients presented with acute myocardial infarction secondary to DES thrombosis. Four additional patients presented with unstable angina and underwent CAN aggressive dilation (3 were also treated for concomitant in-stent restenosis). Dual antiplatelet therapy was recommended in the remaining 9 patients who were asymptomatic at CAN diagnosis, but 1 of them eventually died of cardiogenic shock after a CAN-related myocardial infarction. After a mean follow-up of 399 +/- 347 days, the 1-year event-free survival was 49 +/- 14% and was related to CAN size on IVUS. In 2 patients, CANs disappeared at repeated late angiography and IVUS showed abluminal CAN thrombosis.


CONCLUSIONS
After DES implantation, CANs are rare and may be detected in asymptomatic patients. However, CANs are frequently associated with adverse clinical events as a result of DES restenosis and DES thrombosis. Further studies are required to determine the implications of this distinct new entity.
Alfonso
Fernando
F
Interventional Cardiology Unit, Cardiovascular Institute, Clínico San Carlos University Hospital, Madrid, Spain. falf@hotmail.com
Pérez-Vizcayno
Maria-José
MJ
Ruiz
Miguel
M
Suárez
Alfonso
A
Cazares
Miguel
M
Hernández
Rosana
R
Escaned
Javier
J
Bañuelos
Camino
C
Jiménez-Quevedo
Pilar
P
Macaya
Carlos
C
D000328:Adult; D000368:Aged; D000077144:Clopidogrel; D016001:Confidence Intervals; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D003328:Coronary Thrombosis / Q000209:etiology; D019992:Databases as Topic; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018084:Ultrasonography, Interventional
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine