KMID : 0311120190600090824
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Yonsei Medical Journal 2019 Volume.60 No. 9 p.824 ~ p.831
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Coronary Artery Aneurysm after Second-Generation Drug-Eluting Stent Implantation
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Hong Sung-Jin
Kim Hyo-Eun Ahn Chul-Min Kim Jung-Sun Kim Byeong-Keuk Ko Young-Guk Hong Bum-Kee Choi Dong-Hoon Jang Yang-Soo Hong Myeong-Ki
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Abstract
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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¡¾23.2 mm vs. 28.8¡¾14.8 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.
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KEYWORD
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Coronary artery disease, drug-eluting stent, percutaneous coronary intervention
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