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Short- or long-term outcomes of coronary artery aneurysms occurring after directional coronary atherectomy

Yuji Oikawa1, Junji Yajima, Dominick J Angiolillo

  • 1Department of Cardiology, The Cardiovascular Institute, 7-3-10 Roppongi Minato-ku, Tokyo, Japan. oikawa@cvi.or.jp

The Journal of Invasive Cardiology
|April 10, 2008
PubMed

Insights

Directional coronary atherectomy (DCA) can lead to coronary artery aneurysms (CAAs), but these aneurysms typically do not progress and have an acceptable prognosis. Conservative management is recommended for most DCA-related CAAs.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Coronary artery aneurysm (CAA) is a known complication following percutaneous coronary intervention.
  • Directional coronary atherectomy (DCA) may be associated with a higher incidence of CAA, but its natural history is not well-defined.

Purpose of the Study:

  • To investigate the clinical course and natural history of coronary artery aneurysms (CAAs) that develop after directional coronary atherectomy (DCA).
  • To determine the frequency of DCA-related CAAs and assess their long-term prognosis.

Main Methods:

  • Retrospective analysis of 792 lesions with mid- to long-term follow-up angiography after DCA.
  • Coronary artery aneurysms (CAAs) defined by quantitative coronary angiography (QCA) as a diameter ratio > 1.5.
  • Assessment of target lesion revascularization rates and lumen diameter changes over time.

Main Results:

  • Coronary artery aneurysms (CAAs) were detected in 2.7% (21 of 792) of lesions following DCA.
  • No significant difference in target lesion revascularization rates between CAA and non-CAA lesions.
  • No significant progression in lumen diameter of CAAs during a mean follow-up of 19.6 months; no acute coronary events or perforations observed.

Conclusions:

  • Directional coronary atherectomy (DCA)-related coronary artery aneurysms (CAAs) occur with a notable frequency.
  • DCA-related CAAs demonstrate an acceptable short- and long-term prognosis, with no significant progression observed.
  • Conservative management is generally appropriate for most DCA-related coronary artery aneurysms.

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