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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Coronary Aneurysms After Drug-Eluting Stent Implantation

Clinical, Angiographic, and Intravascular Ultrasound Findings

Interventional Cardiology Unit, Cardiovascular Institute, Clínico San Carlos University Hospital, Madrid, Spain

Manuscript received August 11, 2008; revised manuscript received January 6, 2009, accepted January 12, 2009.

^_* Reprint requests and correspondence: Dr. Fernando Alfonso, Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario, Clínico "San Carlos," Plaza de Cristo Rey, Madrid 28040, Spain (Email: falf{at}hotmail.com).

Objectives: 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 mm² and incomplete apposition area was 12.1 ± 8.6 mm². 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.

Key Words: coronary aneurysm • drug-eluting stents • angiography • intravascular ultrasound

Abbreviations and Acronyms   CAN = coronary aneurysm   CI = confidence interval   DES = drug-eluting stent(s)   IVUS = intravascular ultrasound

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