Surgical management of drug-eluting stent associated coronary artery aneurysms: a case series

Abstract

Drug-eluting stents (DES) have been introduced to counter the in-stent restenosis associated with bare metal stents. However, the mechanism of action of DES results in a counter-productive effect of coronary artery aneurysm (CAA) formation. Although CAA after the implantation of drug-eluting stents (DES) is a rare occurrence with an incidence rate of up to 0.5%, they are increasingly being detected due to the progressive rise in the usage of DES for the management of coronary artery disease (CAD). Due to the rarity of this condition, evidence and guidelines regarding the management strategies for this condition are still lacking. We present a series of 5 cases of CAA, post-DES implantation, who were all successfully managed with surgical intervention.

Keywords: Coronary artery aneurysm; DES; Drug-eluting stent; Percutaneous coronary intervention.

Fig. 1

Coronary angiography images confirming the diagnosis of coronary artery aneurysms (CAA). A Case 2: Coronary angiography reveals a coronary artery aneurysm of 2 × 1.3 cm in the proximal left anterior descending (LAD) artery. B Case 3: Coronary angiography reveals two coronary artery aneurysms of 3.5 × 2.5 cm in the proximal left anterior descending (LAD) artery (yellow arrow) and 2.3 × 2.3 cm in the proximal right coronary artery (RCA) (green arrow). C Case 4: Coronary angiography reveals a coronary artery aneurysm of 2.5 × 0.9 cm in the proximal left anterior descending (LAD) artery. D Case 5: Coronary angiography reveals two coronary artery aneurysms of 2.5 × 2 cm in the proximal left anterior descending (LAD) artery (yellow arrow) and 2 × 1.5 cm in the proximal left circumflex artery (LCX) (blue arrow)