Coronary arterial aneurysms after percutaneous transluminal coronary angioplasty--a not uncommon finding at elective follow-up angiography

Complications of intravascular brachytherapy

INTRODUCTION

There is some evidence of a dose-response relationship for intravascular brachytherapy (IVBT) of native vessel or first-time in-stent restenosis (ISR). It has also been shown that in-field failure predominates following intravascular brachytherapy-treated lesions. Accordingly, it may be advantageous to increase the radiation dose(s) currently used. Given the rationale for escalation from currently doses, a scrutiny of the potential complications that have been reported seems timely.

METHODS

PubMed was searched from 1966 through November 21st, 2023, using the terms coronary and brachytherapy, yielding 1287 references. A 10/16/24 follow-up search of Embase, using the terms "coronary and brachytherapy and complications", yielding 511 articles. In total, 68 articles were identified as adverse event reports based on their title, or by scrutinizing articles that did not mention adverse events in their titles.

RESULTS

The best documented adverse IVBT-related event is the occurrence of late (> 1 month) thrombosis. Following identification of the risk, longer DAPT regimens were adopted, bringing the incidence to non-IVBT levels. A variety of other adverse events have been reported, including aneurysms, dissections, arterial spasm, "black holes" and vasomotor response inhibition. However, none of which were associated with adverse clinical outcomes.

CONCLUSIONS

Nearly all reports regarding IVBT-related complications are retrospective analyses of a limited number of events, subject to reporting bias. Clinically important IVBT-related complications, at current doses, appear highly unlikely.

Coronary artery aneurysm formation after paclitaxel-coated balloon-only intervention for de novo coronary chronic total occlusion

Background

Although coronary artery aneurysm (CAA) is an uncommon complication of drug-coated balloon (DCB) treatment, the incidence and mechanisms CAA formation after DCB intervention for chronic total occlusion (CTO) remains to be clarified. The aim of this study was to investigate the incidence of CAA after DCB intervention for the treatment of CTO of coronary arteries.

Materials and methods

This was a retrospective analysis of 82 patients, contributing 88 vessels, who underwent successful DCB-only treatment for de novo CTO lesions. Follow-up angiography was performed in all cases, at a mean 208.5 (interquartile range [IQR]: 174.8 to 337.5) days after the index procedure.

Results

CAA was identified in seven vessels, in seven patients, at the site of previous successful DCB-only treatment. Of these, six were fusiform in shape and one saccular, with a mean diameter of 4.2 ± 1.0 mm and length of 6.7 ± 2.6 mm. Six CAAs developed at the CTO inlet site, and all CAAs occurred at the lesions following dissection immediately after DCB treatment. CAAs were not associated with an increased risk of major clinical events over the median follow-up of 676.5 (IQR: 393.8 to 1,304.8) days.

Conclusion

The incidence of CAA after DCB-only treatment for CTO lesions was 8.0% in this study. Further research is warranted, using intravascular imaging, to clarify the mechanism of DCB-related CAA formation and prognosis.

Management of a distal coronary psudoaneurysm using an amplatzer vascular plug II

Coronary pseudoaneurysms are rare complications of coronary perforation or dissection that can progress to rupture and cardiac tamponade. There is no optimal standard treatment, and their management is often guided by individual criteria including the risk of rupture, location in the coronary tree, size and flow in it. All of them must be taken into account when deciding the best treatment strategy. We report a case in which an Amplatzer Vascular Plug II (AVP II) was used successfully to occlude a distal coronary pseudoaneurysm that developed early after rescue angioplasty in a woman with a myocardial infarction due to spontaneous coronary dissection.

Giant coronary artery aneurysm following implantation of Endeavour stent presenting with fever

Coronary artery aneurysms are a known but uncommon complication of percutaneous coronary intervention (PCI) probably related to effects of vessel wall trauma and possibly a combination of hypersensitivity and incomplete endothelisation associated with drug-eluting stents (DES). We present here a case of giant coronary artery aneurysm 3 months following implantation of a zotarolimus eluting endeavour stent presenting with fever.

Incidence and natural history of coronary artery aneurysm developing after drug-eluting stent implantation

AIMS

There is a growing concern about the occurrence of coronary artery aneurysms (CAAs) after drug-eluting stent (DES) implantation and their long-term course. We assessed the occurrence and the factors affecting the long-term outcome of DES-associated CAA.

METHODS AND RESULTS

We analyzed 3,612 consecutive patients (4,419 lesions) who underwent follow-up angiography after DES implantation. All 34 CAAs (0.76% per lesion) in 29 patients (0.8% per patient) were detected at follow-up, and the mean elapsed time from DES implantation to CAA diagnosis was 414 ± 213 days. Angiographically, CAAs developed almost exclusively in complex (type B2/C) de novo lesions (30 [88.2%] of 34 lesions), and lesion length was significantly greater in patients with CAA than without CAA (26.9 ± 9.03 vs 23.1 ± 7.14 mm; P = .004). Myocardial infarction with stent thrombosis occurred in 5 patients with CAA (17.2%), 4 of whom were on aspirin only without clopidogrel.

CONCLUSION

Although CAAs rarely develop after DES implantation and show mostly favorable clinical courses, long-term maintenance of clopidogrel therapy might be required to minimize occurrence of adverse clinical events resulting from stent thrombosis.

Coronary artery aneurysms and ectasia: role of coronary CT angiography

Coronary artery dilatations-aneurysms and ectasia-are an uncommon and frequently unrecognized incidental finding in patients with coronary artery disease. Aneurysms and ectasia are associated with a vast group of disorders, and the evaluation and characterization of coronary aneurysms and ectasia represent a great diagnostic task with clinical and therapeutic implications. The underlying etiology is variable and includes degenerative, congenital, inflammatory, infectious, toxic, and traumatic causes. Unlike aneurysms, ectasia is more frequently seen in association with atherosclerosis or as a compensatory mechanism in those cases in which a proximal stenosis is noted in the opposite coronary artery; ectasia is also seen in some coronary artery anomalies, such as anomalous origin from the pulmonary artery, or as a result of a high-flow state, as seen in coronary artery fistulas. The diagnostic approach depends on the clinical scenario, and nowadays, noninvasive evaluation with multidetector computed tomography is possible. Imaging assessment should include evaluation of (a) the distribution, (b) maximal diameter, (c) presence or absence of intraluminal thrombi, (d) number, (e) extension, and (f) associated complications such as myocardial infarction. This article presents an overview of the definition, classification, etiology, clinical manifestations, and potential complications of coronary artery aneurysms and ectasia.

Late giant coronary aneurysm associated with a fracture of sirolimus eluting stent: a case report

A 73-year-old female underwent percutaneous coronary intervention (PCI) because of stable angina. An elective PCI for the RCA lesion was first performed with deploying sirolimus eluting stents (SES). Three weeks later, PCI was also provided in the residual LAD lesion. Eight months later, she presented with new angina. CAG revealed an in-stent restenosis in the mid LAD and a large eccentric saccular coronary aneurysm (17 mm x 9 mm) at the proximal RCA. Intravascular ultrasound (IVUS) showed absence of stent struts around the orifice of aneurysm, which suggested a fracture of SES stent. The entry of coronary aneurysm was finally sealed with a polytetrafluoroethylene-covered stent. This report documented a rare case of late giant coronary artery aneurysm associated with a fracture of SES.

Right coronary artery aneurysm: percutaneous treatment with graft-coated stent during the acute phase of myocardial infarction

We report a case of acute myocardial infarction due to acute thrombosis of the right coronary artery just before a large atherosclerotic aneurysm. The patient was treated with primary percutaneous coronary angioplasty (PCA) and deployment of graft-coated stent with optimal final result. Patients with atherosclerotic coronary aneurysms usually show the same cardiovascular risk factors and the same clinical presentation of patients with atherosclerotic obstructive coronary artery disease, but with an increased risk of endovascular thrombosis and consequently more frequent episodes of distal coronary embolism. Furthermore, they may develop other specific complications, such as rapid aneurysm enlargement and rupture leading to cardiac tamponade. In conclusion, our report shows that percutaneous approach to coronary aneurysms with exclusion of aneurismal lumen by placement of graft-coated stent is a feasible and safety procedure even during the acute phase of myocardial infarction, and it may probably reduce the risk of subsequent distal embolization, improving myocardial perfusion.

A giant coronary artery aneurysm in the right coronary artery

Aneurysms of the coronary arteries are uncommon occurrences that usually develop secondary to atherosclerosis and are often asymptomatic. They are usually diagnosed incidentally during investigation for ischemic heart disease or at autopsy for sudden death. We present a case of a "giant" right coronary artery aneurysm (CAA) discovered incidentally at surgery. Pathological examination confirmed that this was a true aneurysm showing marked thinning of the media and fibrocalcific plaques with small, multifocal areas of lymphocytic infiltrates.

Quantitative assessment of angiographic restenosis after sirolimus-eluting stent implantation in native coronary arteries

BACKGROUND

Sirolimus-eluting stents (SESs) reduce angiographic restenosis in patients with focal, native coronary artery stenoses. This study evaluated the usefulness of SESs in complex native-vessel lesions at high risk for restenosis.

METHODS AND RESULTS

Angiographic follow-up at 240 days was obtained in 701 patients with long (15- to 25-mm) lesions in small-diameter (2.5- to 3.5-mm) native vessels who were randomly assigned to treatment with SESs or bare-metal stents (BMSs) in the SIRIUS trial. Quantitative angiographic measurements of minimal lumen diameter and percent diameter stenosis were obtained within the treated segment, within the stent, and within its 5-mm proximal and distal edges. Patients treated with SESs had lower rates of binary (>50% diameter stenosis) angiographic restenosis within the segment (8.9% versus 36.3% with the BMS; P<0.001) and within the stent (3.2% versus 35.4% with the BMS; P<0.001). SESs were associated with significantly less late lumen loss within the treated segment, within the stent, and within its 5-mm proximal and distal edges (all P<0.001). The reduction of restenosis with the SES was consistent in patients at risk for restenosis, including those with small vessels, long lesions, and diabetes mellitus. The frequency of late aneurysms was similar in the 2 groups.

CONCLUSIONS

Compared with BMSs, SESs reduced angiographic late lumen loss within the stent and its adjacent 5-mm margins in patients with complex native-vessel lesions.

Formation of a coronary artery aneurysm after inflation of a PercuSurge GuardWire distal protection balloon

Formation of aneurysms in the coronary arteries with the use of the PercuSurge distal protection system has not been reported. We describe a 54-year-old man with acute myocardial infarction who was treated with the PercuSurge system. Angiography performed 2 weeks later revealed an aneurysm in the area of inflation of the distal protection balloon.

Coronary artery aneurysms: A 25-patient study

Coronary artery aneurysm is a rare disorder, characterized by abnormal dilatation of a localized portion or diffuse segments of the coronary artery. We studied clinical demographics, catheterization findings, and clinical outcomes in an Asian patient cohort with documented coronary artery aneurysms. Compared to a Caucasian adult population, our patient cohort had a lower incidence of coronary artery aneurysm (0.25% vs. 2.6%), and more patients with nonobstructive coronary artery aneurysms (70%); age, gender, and coronary distribution were comparable. The initial presentation of myocardial infarction occurred in five patients (5/17, 30%) with nonobstructive coronary artery aneurysms; however, none who were receiving preventive medications consisting of anticoagulant and antiplatelet agents subsequently developed myocardial infarction. We conclude that the incidence of coronary artery aneurysms with or without associated significant coronary stenosis seems to be lower in the Asian population. In contrast, the incidence of nonobstructive coronary artery aneurysms is considerably high and should not be thought of as a relatively benign disease entity if not treated with preventive medications. Rheumatoid arthritis-related vasculitis might be a cause of coronary artery aneurysm. Surgical intervention is based on the severity of coronary artery stenosis. The result of medical treatment has been compatible with long-term survival. Cathet. Cardiovasc. Intervent. 48:31-38, 1999.

Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction

We describe the occurrence of a localized saccular pseudoaneurysm in a 69-year-old patient 2 weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. The therapy of perforations requires prolonged balloon inflations, perfusion balloons, covered stents, or surgery. Coronary peudoaneurysm formations are rare; their therapy requires covered stents or surgery. Cathet. Cardiovasc. Intervent. 47:341-346, 1999.

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.

Coronary artery aneurysm development after successful primary stent implantation

This case report describes a patient who developed an aneurysmatic dilation of a coronary artery 6 months after successful primary stent implantatIon. The dilation occurred within the stented segment of the artery. To our knowledge, this is the first report of the development of an aneurysm, in the absence of angiographically visible dissection or other possible causative factors.

Coronary artery aneurysm: a review

Coronary artery aneurysm is defined as coronary dilatation which exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. This is an uncommon disease which has been diagnosed with increasing frequency since the advent of coronary angiography. The incidence varies from 1.5% to 5% with male dominance and a predilection for the right coronary artery. Atherosclerosis accounts for 50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture and vasospasm. The natural history and prognosis remains obscure. Controversies persist regarding the use of surgical or medical management. The authors recommend surgery based on the severity of associated coronary stenosis rather than the mere presence of aneurysm. Medical therapy is indicated for the majority of patients and consists of antiplatelet and anticoagulant medication.

Frequency and outcome of development of coronary artery aneurysm after intracoronary stent placement and angioplasty. STRESS Trial Investigators

Elective Palmaz-Schatz intracoronary stent implantation does not increase the risk for coronary artery aneurysm formation. Angiographic restenosis and clinical outcome are not affected by the development of a coronary artery aneurysm after percutaneous transluminal coronary artery or stent placement.

Coronary artery aneurysms after angioplasty and atherectomy

Coronary artery aneurysm formation after percutaneous transluminal coronary angioplasty and directional coronary atherectomy is unusual. We report the case of a left anterior descending coronary artery aneurysm that formed in such a patient. The left anterior descending coronary artery was bypassed and the aneurysm was plicated with the aid of coronary angioscopy. The English-language medical literature on the topic of coronary artery aneurysms is reviewed.

Coronary artery ectasia: local pathology or diffuse disease?

It is not known whether general or local factors influence the pathogenesis of coronary ectasia. We analyzed prospectively coronary angiograms from 2,186 consecutive patients with 32 patients (1.5%), identified as having coronary artery ectasia. Sixteen subjects had coronary ectasia in more than one segment of the same or a different artery. In 20 of 72 (28%) ectatic segments there was a proximal, related stenosis. In these cases ectasia was more often saccular than fusiform (16 vs. 4) compared to ectasia without a proximal, related stenosis (21 vs. 31, P = 0.003), and the mean length of the ectatic segment was shorter (8.0 vs. 15.1 mm, P = 0.013). Subjects with ectasia after a stenosis often had other ectatic segments unrelated to stenoses. The high incidence of multisegment involvement suggests that coronary ectasia results from a diffuse abnormality of the vessel wall. In predisposed individuals localized ectasia may follow a stenosis, suggesting poststenotic dilatation.

Contained rupture following percutaneous transluminal coronary angioplasty: long-term outcome

Coronary artery aneurysm formation can occur as a complication of balloon angioplasty. We present a case of a contained rupture of the left circumflex artery following angioplasty which resulted in an unusual pseudoaneurysm on angiography at 3-year follow-up.

Relation of deep arterial resection and coronary artery aneurysms after directional coronary atherectomy

OBJECTIVES

The aims of this study were to document the frequency of coronary artery aneurysm formation in patients undergoing directional coronary atherectomy and to determine the relation of such aneurysms to the depth of arterial resection.

BACKGROUND

Deep arterial injury is relatively frequent with the use of directional coronary atherectomy, but the potential for subsequent coronary artery aneurysm formation is unknown.

METHODS

Results in a consecutive series of 64 successfully treated patients (a total of 69 lesions; mean angiographic follow-up at 5 months) treated with directional coronary atherectomy were retrospectively analyzed with use of quantitative angiographic and histologic data.

RESULTS

Coronary aneurysms (ratio of dilated vessel segment to the adjacent reference segment > 1.2:1) occurred in seven patients (10%). The only significant clinical correlate of aneurysm formation was a relatively shorter duration of angina. There were no significant preprocedural angiographic predictors of aneurysms, although 6 (86%) of the 7 aneurysmal lesions arose from restenosis lesions compared with 30 (48%) of 62 lesions with no subsequent aneurysm development (p = 0.06). Histopathologic examination of 414 specimens from 68 treated lesions showed no significant difference in the occurrence of subintimal resection (media +/- adventitia) between those with and without subsequent aneurysm (29% vs. 22%). Media alone was found in 14% of specimens from lesions that later became aneurysmal versus 15% of those that did not; adventitial resection was found in 14% and 7% of specimens, respectively (p = 0.08), with relatively more adventitia per specimen from those with aneurysm (55% vs. 30% without aneurysm, p = 0.08).

CONCLUSIONS

Aneurysms occur relatively frequently after directional coronary atherectomy. Although there was no statistically significant correlation with the depth of arterial resection, the evidence from this study suggests that the role of adventitial resection in the occurrence of late aneurysm development should be explored further.

Long-term results of directional coronary atherectomy: predictors of restenosis

OBJECTIVES

This study was performed to obtain better understanding of the long-term clinical efficacy of directional coronary atherectomy.

BACKGROUND

Although this procedure yields favorable acute results, its acceptance has been limited by the perception that late results (that is, freedom from restenosis) are no better than those of conventional angioplasty.

METHODS

A total of 225 atherectomies performed in 190 patients between August 1988 and July 1991 were examined. Minimal lumen diameter of the treated segments was measured on angiograms obtained before, after and 6 months after intervention.

RESULTS

Although most lesions (97%) had one or more characteristics predictive of unfavorable short- or long-term results after conventional angioplasty, atherectomy was successful in 205 lesions (91%) with a mean residual stenosis of 7 +/- 16%. After subsequent balloon angioplasty in 16 unsuccessful atherectomy attempts, procedural success was 98%. There were no deaths or Q wave myocardial infarctions, and one patient (0.5%) underwent emergency bypass surgery. Six-month angiographic follow-up was obtained in 77% of the eligible patients. The overall angiographic restenosis rate was 32%. Predictors of a lower restenosis rate included a postprocedure lumen diameter > 3 mm (24% vs. 39%, p = 0.047), serum cholesterol < or = 200 mg/dl (18% vs. 40%, p = 0.018) and recent myocardial infarction (16% vs. 37%, p = 0.034). Life-table analysis showed a 2% mortality rate and a 26% incidence of other events (myocardial infarction, repeat revascularization) within the 1st year. The annual 5% mortality rate and 7% incidence of other events during years 2 and 3 were related in large part to the existence or progression of disease at other locations.

CONCLUSIONS

Six-month angiographic follow-up of patients who underwent directional coronary atherectomy during the 1st 3 years of our experience shows an overall restenosis rate of 32%, with lower rates in patients with a postatherectomy lumen diameter > or = 3 mm, cholesterol level < or = 200 mg/dl or a recent myocardial infarction. Few if any events relating to the site of atherectomy developed after the 1st year of follow-up.

Case report: formation of vessel aneurysm after stand alone coronary excimer laser angioplasty

Formation of aneurysms in coronary arteries can be observed following percutaneous transluminal balloon angioplasty but has not been reported previously after coronary excimer laser angioplasty in humans. Stand alone coronary excimer laser angioplasty was performed in a 49-year-old man with a 75% left anterior descending artery stenotic lesion and exertional angina, documenting a good angiographic result postintervention. Control angiography 6 months after the procedure revealed an aneurysm distal to a 90% restenosis in the area of ablation.

Restenosis following coronary angioplasty

Restenosis is the most important problem limiting the success of coronary angioplasty. Clinically, restenosis is seen in approximately one-third of patients undergoing percutaneous transluminal coronary angioplasty. Several clinical and angiographic risk factors have been identified which may contribute to the development of restenosis. Histopathologic studies indicate that restenosis is characterized by intimal proliferation of smooth muscle cells in a loose connective tissue matrix. These intimal lesions are associated predominantly with the nonatheromatous portion of the vessel wall. Thinning of the media of the plaque-free wall and marked fragmentation of the internal elastic lamina are also seen. Traumatic injury of the vessel wall during angioplasty probably triggers a series of cellular and subcellular events which may ultimately lead to myointimal proliferation and restenosis. Although the exact mechanism by which this occurs is unknown, several factors may enhance smooth muscle cell growth and therefore may play a role in the development of restenosis. These include platelet deposition, mechanical stretching of the media, inflammation of the vessel wall, the activity of growth factors, and alterations in vessel geometry. These possible mechanisms of restenosis suggest several potential ways to limit the proliferative response to vascular injury. Anticoagulants and platelet antagonists, direct inhibitors of smooth muscle proliferation, anti-inflammatory agents, growth factor inhibitors, and new devices which improve final vessel geometry are currently being tested as methods to curb restenosis. Unfortunately, no treatment has yet been shown to reduce significantly the rate of restenosis following angioplasty. The problem of restenosis will most likely be solved by better understanding of the basic molecular and biologic phenomena involved in vascular injury and repair.

Coronary artery aneurysms--a case study and literature review

Coronary artery aneurysms are detected with increasing frequency owing to the advent of coronary angiographies. Although most patients with coronary artery aneurysms are asymptomatic, manifestations of myocardial ischemia may occur. The case described herein serves as a basis for a discussion of the pathogenesis, clinical manifestations, detection, and treatment of coronary artery aneurysms.

Predictability and prognosis of PTCA-induced coronary artery aneurysms

The natural history of coronary aneurysms, defined as local dilatations exceeding the diameter of the normal adjacent vessel segments by at least 1.5 times, is not significantly different from the natural history of nonaneurysmal coronary disease. However, little is known about the prognosis of percutaneous transluminal coronary angioplasty (PCTA)-induced coronary aneurysms. Therefore, we investigated the occurrence and the medium long-term prognosis of such aneurysms in 728 patients who, after successful PTCA, underwent repeat coronary angiography at mean 4.5 months post-PTCA. A coronary aneurysm at the site of PTCA ws noted in 3.9% of patients (n = 28). Of the potentially predictive factors analyzed, only a coronary dissection at the time of PTCA had statistically significant influence. The long-term prognosis of PTCA-induced coronary aneurysms was excellent. One patient underwent (unrelated) cardiac surgery, all other 27 patients remained eventfree. We conclude that the same benign nature of coronary aneurysmal disease holds true for those aneurysms that develop after PTCA.

Coronary atherectomy. Clinical, angiographic, and histological findings and observations regarding potential mechanisms

Between August 5, 1988 and August 1, 1989, we attempted percutaneous directional coronary atherectomy of 76 lesions, including 42 primary lesions and 34 restenosis lesions that developed after one or more prior interventions. The procedure was successful in 67 lesions (88%), with a decrease in diameter stenosis from 80 +/- 11% to 5 +/- 15% after atherectomy (p less than 0.01). One or more complications occurred in six patients (9%), including non-Q wave myocardial infarction (three patients, 4.5%), femoral arterial injury requiring surgical repair (two patients, 3%), and proximal dissection leading to emergency bypass surgery (one patient, 1.5%). Despite these favorable acute results, the 6-month lesion restenosis rate was 30% by life-table analysis. Light microscopy of retrieved tissue revealed atherosclerotic plaque in 94%, media in 67%, and adventitia in 27%. Intimal proliferation was present in 97% of the restenosis lesions but was also evident in 33% of primary lesions. Tissue weight from 27 lesions averaged 18.5 mg (range, 5.8-45.1 mg), which is not adequate to explain the entire angiographic improvement. Thus, part of the improvement in lumen diameter appears to be due to mechanical dilatation rather than to tissue removal alone. Atherectomy can predictably treat selected coronary lesions with overall safety comparable to that of conventional balloon angioplasty, although the procedure as currently performed does not derive all of its benefit from tissue removal and does not appear to prevent restenosis.

Coronary arterial aneurysm after percutaneous transluminal coronary recanalization with streptokinase

A 49-year-old man developed an aneurysm of the right coronary artery after successful thrombolytic therapy with streptokinase following an acute inferior wall myocardial infarction. He was free from symptoms despite the existence of the aneurysm. The possible mechanisms for the formation of the aneurysm are discussed.