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Published on: March 15, 2022
INTERVENTIONAL TRAPS IN ECTATIC CORONARY ARTERIES: A CASE REPORT
Krešimir Gabaldo1,2, Marijana Knežević Praveček1,2, Domagoj Vučić1,2,3
1Department of Internal Medicine, Dr. Josip Benčević General Hospital, Slavonski Brod, Croatia.
Insights
Coronary artery aneurysms increase percutaneous intervention risks, causing the no-reflow phenomenon. This case study shows successful management and recovery despite initial complications in a patient with right coronary artery aneurysm.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery ectasia (CAE) or aneurysms involve arterial dilatation (>1.5x normal diameter), leading to disturbed blood flow and thrombosis.
- Percutaneous coronary interventions (PCI) in CAE carry high risks, notably the no-reflow phenomenon, common in acute coronary syndromes like ST-elevation myocardial infarction (STEMI).
Observation:
- This case details the no-reflow phenomenon in a stable patient undergoing PCI for significant stenosis in an aneurysmally altered right coronary artery.
- Despite prompt stenting, optimized therapy, and thromboaspiration, TIMI 3 flow was not achieved, leading to periprocedural STEMI.
Findings:
- The patient was successfully stabilized post-STEMI, exhibiting unexpectedly good recovery of myocardial function.
- Follow-up angiography at 6 weeks confirmed proper stent patency and restored normal TIMI 3 flow.
Implications:
- This case highlights the challenges of PCI in coronary aneurysms and the potential for successful outcomes despite initial no-reflow complications.
- Effective management strategies can lead to favorable long-term results, even after periprocedural myocardial infarction.
Abstract:
Coronary artery ectasia or aneurysms are dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal. Blood flow through such arteries is disturbed and turbulent, which, with the activation of endothelium, leads to chronic thrombosis in the blood vessel wall. Percutaneous coronary interventions in ectatic / aneurysmal vessels carry a high risk of complications, primarily a "no-reflow" phenomenon. No-reflow is common in patients with acute coronary syndrome, especially ST elevation myocardial infarction (STEMI). In this article, we present the occurrence of the no-reflow phenomenon in a stable patient undergoing percutaneous intervention due to a significant stenosis of the aneurysmally altered right coronary artery. Despite the rapid placement and optimization of stents and the applied drug therapy combined with thromboaspiration periprocedurally, it was not possible to establish TIMI 3 flow. However, after the initial failure and development of periprocedural STEMI, the patient was successfully stabilized with unexpectedly good recovery of infarcted myocardial function. Control coronarography 6 weeks after the initial event confirmed a proper stent patency with normal TIMI 3 flow.
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