Related Experiment Videos
Mid-term follow-up of coronary artery aneurysm after directional coronary atherectomy
1Department of Cardiology, Mitsui Memorial Hospital, Tokyo.
Insights
Coronary artery aneurysms (CAAs) after directional coronary atherectomy (DCA) are common. Deeper resection during DCA is linked to CAA formation, but these aneurysms show a good mid-term prognosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery aneurysm (CAA) is a known complication following directional coronary atherectomy (DCA), occurring in 6-12% of lesions.
- The long-term prognosis and optimal management strategies for DCA-related CAAs remain incompletely understood.
Purpose of the Study:
- To evaluate the clinical course and mid-term prognosis of patients with coronary artery aneurysms (CAAs) that developed after directional coronary atherectomy (DCA).
- To identify factors associated with the formation of DCA-related CAAs.
Main Methods:
- A retrospective analysis of 214 consecutive patients who underwent DCA and were subsequently diagnosed with CAAs.
- Follow-up coronary angiography was performed at 6 months and an average of 32 months post-DCA to assess aneurysm size and clinical outcomes.
- Histological examination of atherectomy specimens was analyzed to correlate tissue resection depth with aneurysm formation.
Main Results:
- Out of 193 patients with follow-up angiography, 14 lesions (14 patients) developed CAAs.
- Twelve of the 14 patients with CAAs remained asymptomatic; two experienced new angina unrelated to the original DCA procedure.
- Deeper subintimal resection during DCA was significantly associated with the development of CAAs (57% in CAA+ group vs. 31% in CAA- group).
- Aneurysm size, relative to reference vessel diameter, increased significantly by 6 months post-DCA and remained stable thereafter.
Conclusions:
- Coronary artery aneurysms following DCA appear to have a favorable mid-term prognosis, with most patients remaining asymptomatic.
- The depth of tissue resection during directional coronary atherectomy is a significant predictor of coronary artery aneurysm formation.
- Routine follow-up angiography is valuable for detecting and monitoring DCA-related CAAs.
Abstract:
Coronary artery aneurysm (CAA) occurs in 6-12% of lesions after directional coronary atherectomy (DCA). The prognosis and the optimal treatment for DCA-related CAAs have not been well known. Therefore, we reviewed the clinical course of 214 consecutive patients with DCA-related CAAs who underwent DCA in our hospital. Follow-up coronary angiography 6 months after DCA was completed in 193 patients (212 lesions) and 14 lesions with CAAs (14 patients) were detected. We evaluated these 14 lesions by repeat coronary angiography at an average of 32 months after DCA in comparison with the adjacent reference vessel. Twelve of the 14 patients have been uneventful but 2 suffered from de novo angina due to new stenotic lesion unrelated to the DCA procedures. We compared the preprocedural angiographic characteristics and periprocedural parameters between the 14 lesions with CAAs[CAA(+)group] and the 198 without CAAs [CAA(-)group], but found no significant differences. Histological examination of specimens retrieved during atherectomy demonstrated that subintimal resection was more frequent in the CAA(+)group(57%) than the CAA(-)group(31%). The diameter of the aneurysm divided by the reference diameter was significantly larger at 6 months immediately after DCA(1.71 +/- 0.21 vs 1.31 +/- 0.18, p < 0.05) but did not change subsequently (1.68 +/- 0.23). Our retrospective analysis revealed a good mid-term (an average of 32 months) prognosis for CAAs found by routine follow-up coronary angiography and also demonstrated that the depth of resection was significantly associated with aneurysm formation.