This article has Open Peer Review reports available.
A new device to seal large coronary aneurysms: a case report
© Danzi et al; licensee BioMed Central Ltd. 2010
Received: 2 December 2008
Accepted: 3 August 2010
Published: 3 August 2010
Coronary artery aneurysm is an uncommon disease. It is defined as a coronary artery dilatation, exceeding the diameter of the normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Coronary artery aneurysms are typically diagnosed by coronary angiography. The prognosis of coronary artery aneurysm is not well known and the management is challenging.
A 68-year-old Italian-Caucasian man presented to our hospital with angina. Coronary angiography revealed a large coronary aneurysm of the right coronary artery, which was successfully treated by the percutaneous implantation of an MGuard™stent.
This case report provides evidence that coronary artery aneurysms, even if very large, can be safely treated by MGuard™stent implantation. We strongly emphasize the high flexibility and good deliverability of this device, which leads to the complete exclusion of the aneurysm mediated by the process of endothelization of its thin mesh sleeves.
A 68-year-old Italian-Caucasian man who had a previous angioplasty to an obtuse marginal branch presented to our institution for angina and a positive myocardial perfusion imaging test (reversible perfusion defects on inferior wall). An angiography showed a patent stent on obtuse marginal artery and a large coronary aneurysm of the right coronary artery (6.7 mm in diameter and 15.2 mm in length) (Figure 1b; additional file 1)[1, 2]. A 3.5 to 24 mm long MGuard™stent was implanted, using a pressure of 16 bar (additional file 2). After stent deployment, the injection of dye showed partial opacification of the aneurysmal sac through the holes of the net, with some stagnation of blood (Figure 1c; additional file 3). His hospital stay was uneventful and our patient was discharged the day after the procedure with dual anti-platelet therapy. At one month our patient was totally asymptomatic. The coronary computed tomography (CT) scan showed a good stent apposition (Figure 1e,f) with complete exclusion of the aneurysm that was also confirmed by angiography (Figure 1d; additional file 4).
Coronary artery aneurysms may be complicated by thrombosis and rupture. The optimal treatment options of coronary aneurysms are still largely debated. They include anticoagulation, covered stents, reconstruction, resection and exclusion with bypass . The PTFE-covered stents have been used to treat coronary artery aneurysms, but the restenosis rate and long-term effectiveness of covered stents are unknown. The newly developed balloon-expandable MGuard™stent system with its combination of an ultra-thin polymer mesh sleeve attached to the external of a bare metal stent surface has been designed to provide embolic protection during percutaneous coronary intervention restenosis by bare metal stents, peripheral embolism following stent implantation in vein grafts, and conditions in which there is a discontinuity of the coronary lumen (rupture or perforation, aneurysm, and fistula). This device demonstrated excellent performance in a highly complex lesion subset such as cover coronary artery perforations or arteriovenous fistulas with high success and acceptable rates of acute complications. Based on its technical features, we decided to use the MGuard™stent to seal a coronary artery aneurysm. This experience suggests a new potential indication for the use of MGuard™coronary stent as an attractive alternative treatment with less risk of in-stent restenosis. In human coronary arteries the complete exclusion of the aneurysmal sac (that is mediated by the process of endothelization of the ultra-thin PET mesh sleeve) is not immediate and seems to require at least four weeks. The high flexibility and the good deliverability make the MGuard™device an attractive alternative to the currently available covered stent for an effective treatment of coronary aneurysm.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG, Mudd JG, Gosselin AJ: Aneurysmal coronary artery disease. Circulation. 1983, 67: 134-138.View ArticlePubMedGoogle Scholar
- Eng J, Nair KK: Giant coronary aneurysm. J Cardiovasc Surg. 1993, 34: 339-340.Google Scholar
- Mushabbar S, Lesch M: Coronary artery aneurysm: a review. Prog Cardiovasc Dis. 1997, 40: 77-84. 10.1016/S0033-0620(97)80024-2.View ArticleGoogle Scholar
- Gurtu R, Uemura H, Tsuda E, Dubrey SW: Giant coronary artery aneurysms and myocardial infarction: aetiology and management. Br J Hosp Med. 2007, 68: 618-619.View ArticleGoogle Scholar
- Demopoulos VP, Olympios CD, Fakiolas CN, Pissimissis EG, Economides NM, Adamopoulou E, Foussas SG, Cokkinos DV: The natural history of aneurismal coronary artery disease. Heart. 1997, 78: 136-141.View ArticlePubMedPubMed CentralGoogle Scholar
- Harandi S, Johnston SB, Wood RE, Roberts WC: Operative therapy of coronary arterial aneurysm. Am J Cardiol. 1999, 83: 1290-1293. 10.1016/S0002-9149(99)00079-X.View ArticlePubMedGoogle Scholar
- Briguori C, Saris C, Sivieri G, Takagi T, Di Mario C, Colombo A: Polytetrfluoroethylene-covered stent and coronary artery aneurysms. Cathet Cardiovasc Intervent. 2002, 55: 326-330. 10.1002/ccd.10063.View ArticleGoogle Scholar
- Szalat A, Durst R, Cohen A, Lotan C: Use of polytetrfluoroethylene-covered stent for treatment of coronary artery aneurysm. Cathet Cardiovasc Intervent. 2005, 665: 203-208. 10.1002/ccd.20448.View ArticleGoogle Scholar
- Kaluski E, Groothuis A, Klapholz M, Seifart P, Edelman E: Coronary stenting with M-GUARD: feasibility and safety porcine trial. J Invasive Cardiol. 2007, 19: 326-330.PubMedGoogle Scholar
- Costa Jde R, Costa R, Feres F: Preliminary Experience with the Novel MGuardTM Stent System Containing a Protection Net to Prevent Distal Embolization - Results From a Prospective, Non-Randomized, Single Center Study. Abstract Circulation. 2008, 118: S-745-Google Scholar
- Everett JE, Burkhart HM: Coronary artery aneurysm: case report. J Cardiothorac Surg. 2008, 3: 1-10.1186/1749-8090-3-1.View ArticlePubMedPubMed CentralGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.