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Images in cardiovascular medicine
Use of polytetrafluoroethylene (PTFE)-covered stent in treatment of RCA aneurysm
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  1. Saroj Neupane,
  2. Kathleen Dass
  1. Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
  1. Correspondence to Dr Saroj Neupane, Department of Internal Medicine, William Beaumont Hospital, 3601 W 13 Mile Road, Royal Oak, MI 48073, USA; Neupane.saroj99{at}gmail.com

https://doi.org/10.1136/heartasia-2014-010572

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    A 55-year-old man presented to the emergency room with acute severe retrosternal chest pain radiating to his left arm. His past medical history includes coronary artery disease (CAD) with multiple percutaneous coronary interventions (PCI). The patient was asymptomatic before this episode. He was haemodynamically stable, and physical exam was unremarkable. EKG showed sinus bradycardia without ischaemic changes. Cardiac biomarkers were normal. He underwent cardiac catheterisation, which showed a 10 mm right coronary artery (RCA) aneurysm at the site of a previously placed drug eluting stent (figure 1 and online supplementary video 1). He underwent PCI with polytetrafluoroethylene (PTFE)-covered stent (Jostent) to the RCA aneurysm, resulting in complete resolution of chest pain (figure 2 and online supplementary videos 2 and 3). He was discharged on dual antiplatelet therapy of aspirin and prasugrel.

    Figure 1
    Figure 1

    Coronary angiography showing right coronary artery aneurysm at the site of previously placed Drug eluting stent.

    Figure 2
    Figure 2

    Cessation of flow to aneurysmal sac after covered stent placement.

    Coronary artery aneurysms are rare (1.5%–5%) and have a predilection to the RCA.1 Though atherosclerotic CAD is the most common cause, coronary aneurysms after placement of drug eluting stents have been increasingly reported.1 Presentation is highly variable, ranging from incidental asymptomatic finding during angiography to more severe complications like rupture, thrombosis, distal embolisations, infarction and sudden cardiac death.1 Treatment includes surgery, percutaneous covered stents or conservative management with antiplatelet therapy.1 ,2 Choice of therapy depends on size of the aneurysm, thrombus burden and presence of complications like cardiac haematomas, however, there is no consensus on the ideal approach to management.1 ,2 The placement of a PTFE-covered stent to prevent blood flow to aneurysmal sac through PCI is a safer, less invasive alternative to surgery.2

    References

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      1. Ruiz-Nodar JM,
      2. Valencia J,
      3. Pineda J
      . Coronary aneurysms after drug-eluting stents implantation. Eur Heart J 2007;28:2826.
      OpenUrlFREE Full Text
    2. ↵
      1. Bajaj S,
      2. Parikh R,
      3. Hamdan A, et al
      . Covered stent treatment of coronary aneurysm after DES placement. Tex Heart Inst J 2010;37:449–54.
      OpenUrlPubMed

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

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    Footnotes

    • Contributors The authors have participated sufficiently in the conception and design of the work, in the analysis of the data and in writing the manuscript to take public responsibility for it.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • ▸ Additional material is available. To view please visit the journal (http://dx.doi.org/10.1136/heartasia-2014-010572).