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Published on: November 19, 2020
[Late localized aneurysmal dilations after sirolimus-eluting stents in 4 patients]
Hong Liu1, Shu-zheng Lü, Yun-dai Chen
1Department of Cardiology, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.
Insights
Late aneurysmal dilations after sirolimus-eluting stents are linked to recurring chest pain post percutaneous coronary intervention (PCI). Treatment with tirofiban resolved symptoms, indicating a connection between angina and these specific stent-related dilations.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Context:
- Sirolimus-eluting stents (SES) are widely used for coronary artery disease.
- Late stent malapposition and aneurysmal changes can occur post-stenting.
- Understanding the etiology of these complications is crucial for patient management.
Purpose:
- To investigate the cause of late localized aneurysmal dilations in patients following SES implantation.
- To analyze the clinical presentation and angiographic findings associated with these dilations.
Summary:
- Four patients developed late localized aneurysmal dilations (16-22 months post-PCI) after SES implantation.
- These dilations were associated with recurrent angina pectoris, despite successful initial stenting and no early thrombosis.
- Angiography confirmed aneurysms at stented sites; symptoms resolved after tirofiban treatment.
Impact:
- This study highlights a potential link between recurrent angina and late aneurysmal changes after SES.
- It suggests that tirofiban may be an effective treatment for such presentations.
- Findings contribute to the understanding of rare SES complications and inform clinical practice.
Objective:
To analyze the reason of coronary artery aneurysmal dilations in patients after sirolimus-eluting stent implantation.
Methods:
Late localized aneurysmal dilations post PCI were evidenced in 4 patients (age 69.5 +/- 3.5 years, 3 males) during follow-up (24.8 +/- 1.8 months). Nine stents were implanted into 7 diseased vessels: 5 Cypher select stents in LAD; 2 Firebird stents and 1 Pixel stent in LCX; 1 Cypher select stent in RCA. Clopidogrel (75 mg/d) was used for one year.
Results:
All stents were implanted successfully after predilation. No acute or subacute in-stent thrombosis and MACE was recorded. Follow-up angiogram imaging at 12 months after stenting was normal in all patients. Chest pain reoccurred in these 4 patients at 16, 18, and 22 months post stent implantation and patients were rehospitalized and treated with clopidogrel, asprine, and intravenous nitroglycerin. Angiography showed aneurysmal segment at the stented site of LAD in 3 patients, and at RCA in 1 patient. The symptom disappeared after 3 days intravenous tirofiban treatments and discharged without in-hospital complications. Patients remained symptom-free 3 - 6 months post discharge.
Conclusion:
Late localized aneurysmal dilations after sirolimus-eluting stents are related to reoccurred angina pectoris post PCI.
