Transcript Diapositive 1 - American Heart of Poland

Call for CASES
Percutaneous closure of coronary
artery aneurysm:
long term implication
Leszek D. Stachaczyk, MD
Pawel Buszman, MD, FESC, FSCAI
American Heart of Poland, Ustroñ, Poland
&
CCU, Upper-Silesian Center of Cardiology, Silesian Medical
School, Katowice, Poland
Introduction
Atherosclerosis of coronary artery may result in
lumen narrowing or anurysm formation.
Coronary anurysm enhances the risk of local
thrombosis and/or peripheral embolisation.
There is no established treatment for large coronary
aneurysms.
Description of the problem
Case report:
• Age 47 / male
• Symptoms: Unstable Angina.
• Medical History: non-Q myocardial infarction in
1994.
• Risk factors: Hypercholesterolaemia, ex-smoker.
Description of the problem
• Concomitant treatment
stenosis and aneurysm.
of
coronary
artery
• Percutaneous
closure
of
left
anterior
descending coronary artery aneurysm with
stent graft.
Left anterior descending coronary
artery aneurysm.
Coronary angiography:
LCA:
LM-short, without narrowing
LAD-proximal aneurysm (diam. ca 5-6mm),
critical narrowings in med segment (90 and
75%)
Cx-50-60% lesion in med segment.
RCA: dominant, normal.
LCA: RAO 30
Intended strategy
Technical data:
• Guiding catheter: Judkins Left 4, 7F
• Stent graft Jostent 3.0x16mm on balloon 3.5x20mm
Quantuum
• Predilatation of LAD and placement of a PTFE – covered
stent
• Direct stenting to med Cx
Stenting
• Administration
of
ticlopidine and ASA 2 days
before procedure
• Routine
anticoagulation
during procedure.
• Predilatation
and
stent
implantation
to LAD (3.0 / 16mm
Jostent
coronary
stent
graft with 16 atm)
• Direct stenting to med Cx
Acute Result
• TIMI 3 flow after
stent implantation
• Non
significant
residual stenosis
• No complication
Long-term sequel
• Acute MI after 6
months (late in-stent
thrombosis)
• Successful
thrombolysis
combined with IIb/IIIa
inhibitor.
Summary
• A 47 year old male with unstable angina was addmitted to
the hospital for interventional diagnosis and treatment.
• Coronary angiography showed a LAD eccentric aneurysm
and double-vessel coronary artery disease (LAD, Cx).
• The aneurysm and the lesion in proximal portion of LAD
were treated with stent graft. The lesion more distally was
treated with balloon angioplasty. Lesion in the Cx was
stented.
• Patient left hospital on combined antiplatelet therapy with
aspirin and ticlopidine ordered for 3 months.
• After 6 months patient suffered from anterior AMI caused
by late in-stent thrombosis, which was successfully treated
with thrombolysis and IIb/IIIa inhibitor.
Message
• Percutaneous
coronary
aneurysm
closure with Jostent Graft is feasible
and efficient.
• The use of this stent requires an
extended
course
of
double
antiplatelet therapy.