Coronary aneurysms after catheter interventions: an exception to "bigger is better"

Risk factors for coronary artery ectasia and the relationship between hyperlipidemia and coronary artery ectasia

BACKGROUND

Coronary artery ectasia (CAE) is the aneurysmal dilatation of the coronary artery, recognized as a special clinical form of coronary stenosis besides atherosclerosis. Its exact pathophysiological mechanism remains unknown. Moreover, few studies have focused on the relationship between triglyceride and CAE. We aimed to find the risk factors for CAE and analyze the relationship between serum lipid and CAE.

PATIENTS AND METHODS

We conducted a prospective cohort study on patients admitted because of typical or atypical chest discomfort suggestive of angina in Zhongda Hospital affiliated to Southeast University from January 2010 to June 2018. We included 100 consecutive patients with CAE; the control group included 100 consecutive patients with coronary atherosclerosis and no ectasia. We recorded and compared the general data, cardiovascular risk factors, blood examination index, and coronary angiography data between the two groups. t-Test, Mann-Whitney U-test, χ-test, logistic regression analysis, and receiver operating characteristic curve analysis were used for statistical analysis to assess the risk factors for CAE and analyze the relationship between hyperlipidemia and CAE.

RESULTS

Sex, weight, BMI, diastolic blood pressure, hypertension, hemoglobin, D-dimer, triglyceride, total cholesterol, and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio were significantly higher in the CAE group than in the control group (P=0.0028, 0.001, <0.001, <0.001, 0.008, <0.001, 0.050, <0.001, 0.043, and 0.004, respectively). Logistic regression analysis showed that sex, BMI, diastolic blood pressure, D-dimer, triglyceride, and LDL/HDL ratio were independent risk factors for CAE [odds ratio (OR)=2.076, 95% confidence interval (CI)=1.232-2.673, P=0.016; OR=1.184, 95% CI=1.607-1.436, P<0.001; OR=1.177, 95% CI=1.026-1.264, P=0.007; OR=1.004, 95% CI=1.002-1.007, P=0.019; OR=3.736, 95% CI=2.028-6.883, P<0.001; and OR=1.569, 95% CI=1.229-2.419, P=0.026, respectively]. The receiver operating characteristic curve for the model combining triglyceride with LDL/HDL ratio for predicting CAE showed an area under the curve of 0.706 and 95% CI of 0.634-0.778 (P<0.001). Sex, BMI, diastolic blood pressure, D-dimer, and triglyceride combined with LDL/HDL ratio have a better predictive value for CAE (area under the curve=0.898, 95% CI=0.849-0.947, P<0.001).

CONCLUSION

Sex, BMI, diastolic blood pressure, D-dimer, triglyceride, and LDL/HDL ratio are all risk factors for CAE. Hyperlipidemia has a good predictive value for CAE.

Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review

Spontaneous coronary artery dissection is a rare cause of myocardial ischemia and sudden death. Coronary aneurysms and pseudoaneurysms, which may occur after percutaneous coronary interventions, rarely occur spontaneously. We review the pertinent medical literature and describe the intravascular findings of spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms.

Delayed development of a coronary artery pseudoaneurysm after angioplasty

One month after a successful angioplasty, one of our patients developed a new aneurysm in the right coronary artery (RCA). The aneurysm was characterized as a pseudoaneurysm by the use of intravascular ultrasound (IVUS). A stenosis that was not well seen by angiography was better depicted by IVUS. Both the pseudoaneurysm and the stenosis were successfully treated with a second angioplasty and stenting with a covered stent. Delayed development of pseudoaneurysms after dissection is an uncommon, but possible complication after angioplasty. In this case IVUS was useful for accurate characterization of the aneurysm. The use of covered stents may become a clinically useful method for treating coronary pseudoaneurysms.

Coronary artery aneurysm formation after balloon angioplasty and stent implantation

This study describes coronary angiographic and intravascular ultrasound evaluation of late coronary artery aneurysms after percutaneous balloon angioplasty and bailout stent implantation. Intravascular ultrasound distinguishes true aneurysms from pseudoaneurysms. The discussion is focused on the etiology and prognosis of this rare complication.

Acute directional coronary atherectomy prior to stenting in complex coronary lesions: ADAPTS Study

The purpose of this study was to determine the results of directional coronary atherectomy (DCA) combined with stenting in a high-risk patient population. The use of stenting or DCA alone for aorto-ostial lesions, total chronic occlusions, long lesions, and lesions containing thrombus is associated with lowered success and a relatively high restenosis rate. Between July 1993 and October 1996, we treated 89 lesions with the combined approach of DCA and stenting in 60 consecutive patients. Thirty-one (51.7%) patients were treated because of unstable angina, 11 (18.3%) for post-myocardial infarction (MI) angina, 3 (5.0%) for acute MI, and 15 (25.0%) patients for stable angina. A total of 43 (71.7%) patients had multivessel disease, 19 (31.7%) had undergone previous coronary artery bypass graft (CABG), and 17 (28.3%) patients had undergone multivessel revascularization. The procedure was successful in all patients; and no postprocedural deaths or emergent CABG occurred. Two patients (3.3%) had non-Q-wave MI after the procedure and 1 patient (1.7%) experienced Q-wave MI due to subacute stent closure 7 days after the procedure. During follow-up ranging from 6 months to 3 years, 2 (3.3%) patients died, 2 (3.3%) required CABG surgery, 1 (1.7%) patient had an MI, and 6 patients (10.0%) required target vessel revascularization. By the quantitative coronary angiography, the initial minimal luminal diameter (MLD) averaged 0.91+/-0.45 mm (74.7+/-11.8% stenosis) increasing to 3.80+/-0.44 mm (-6.7+/-12.1%) after the combined approach procedure. Thirty patients (50.0%) met criteria for late (> or =6 months) angiographic follow-up. Late MLD loss averaged 1.13+/-1.07 mm, for a mean net gain of 1.61+/-1.23 mm. Available angiographic follow-up evaluation showed a restenosis rate of 13.3%. A combined approach, defined as the use of both DCA and stenting, is safe and yields a low restenosis rate in high-risk patients who have lesions known to respond less favorably to stenting or DCA alone.

Development of coronary aneurysm after cutting balloon angioplasty: assessment by intracoronary ultrasound

We report the case of a coronary aneurysm observed 6 mo after cutting balloon angioplasty complicated by a mild perforation. Intravascular ultrasound allowed characterization of the malformation as a true aneurysm. The clinical course was uneventful.