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[Successful surgical treatment of coronary aneurysm following PTCA]
M Nakano1, S Horikoshi, H Emoto
1Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Insights
A patient developed a coronary artery aneurysm after percutaneous transluminal coronary angioplasty (PTCA). This complication led to recurrent angina, necessitating further intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery stenosis.
- Complications, though rare, can occur following interventional procedures.
- Coronary artery aneurysms are abnormal dilatations of the coronary arteries.
Observation:
- A 50-year-old man presented with severe effort angina due to 99% stenosis in the right coronary artery (RCA).
- Initial balloon angioplasty of the RCA lesion resulted in sufficient dilatation but left a small dissection.
- Two months post-PTCA, the patient experienced recurrent angina, with repeat angiography revealing aneurysm formation at the dissection site.
Findings:
- The initial PTCA procedure, despite successful dilatation, led to a small arterial dissection.
- A significant coronary artery aneurysm developed at the site of the previous dissection.
- Recurrent angina symptoms correlated with the aneurysm formation and residual stenosis.
Implications:
- Coronary artery aneurysms following PTCA are a potential, albeit uncommon, complication.
- Close monitoring is crucial after angioplasty, especially if dissections occur.
- Surgical intervention, such as coronary artery bypass grafting, may be required for managing such complications.
Abstract:
A case of 50-year-old man who developed coronary aneurysm at the initial PTCA site following dilatation was reported. The patient was suffered severe effort angina pectoris and admitted to our hospital. Coronary angiography revealed 99% stenosis in the right coronary artery (RCA), and the underwent balloon dilatation of the RCA lesion with 3.0 mm balloon catheter at 3 atm of pressure. PTCA provided sufficient coronary dilatation, however a small dissection remained. He was discharged from the hospital without any symptom. Two months after PTCA he was suffered from recurrent angina, and electrocardiographic exercise stress test was positive for ST segment depression in inferior wall. The repeat coronary angiography showed severe stenosis of the original lesion and aneurysm formation at the area of dissection which occurred during initial angioplasty. Coronary artery bypass surgery with a saphenous vein graft performed successfully.