A Self-Expandable Coronary Stent System to Treat Complex Coronary Stenosis Complicated by Poststenotic Aneurysm: An Optical Coherence Tomographic Evidence-Based Case Report
- Volume 23 - Issue 12 - December 2011
- Posted on: 12/2/11
- 0 Comments
- 3746 reads
ABSTRACT: Coronary artery aneurysm is a relatively uncommon disorder characterized by coronary artery dilatation with diameter that exceeds 50% of the normal adjacent segments with atherosclerosis being the most common etiology.1 Aneurysms can be adjacent to a stenosis in a post- or prestenotic location. Both anatomical conditions are technically challenging regarding their percutaneous treatment because of the large discrepancy in size between the stenotic and dilated segments, and require careful choice of the most appropriate technique and device. We have successfully treated a coronary stenosis complicated by a poststenotic aneurysm in a 60-year-old patient with atypical angina using a novel self-expandable coronary stent system implanted with optical coherence tomography (OCT) guidance. OCT scan after implantation showed residual stent malapposition inside the aneurysm despite postdilatation. Thanks to the ability of this stent to self-expand over time, 6-month OCT follow-up showed an optimal result in terms of stent apposition, strut coverage, and absence of in-stent restenosis.
J INVASIVE CARDIOL 2011;23(12):E277-E280
Coronary artery aneurysm is relatively uncommon, with incidence from 0.3% to 4.9%, characterized by coronary artery dilatation with diameter that exceeds 50% of the normal adjacent segments.1 Atherosclerosis is the most common etiology in adults.2,3 Weakening of the tunica media and hemodynamic factors play an important role in the formation of aneurysms. The observation of poststenotic aneurysms suggests the transformation, beyond the stenosis, of potential energy into kinetic energy resulting in increased lateral pressure and dilation of the vessel wall downstream of the stenosis. Aneurysms can also be prestenotic, the formation of which is linked to the increased lateral pressure upstream from the stenosis.4,5 Indications for the treatment of this disorder and the techniques to use remain to be determined.6 In the presence of a poststenotic aneurysm, the percutaneous treatment of the stenosis presents considerable technical difficulties caused by the large discrepancy in size between stenosis and dilatation. This condition requires careful choice of the best device to be used and represents a challenge for the interventional cardiologist. The Stentys stent (STENTYS S.A.) is a novel self-expandable coronary stent system designed to allow optimal adaptation of the stent struts to the vessel wall in order to reduce the occurrence of stent malapposition that is considered one of the most powerful morphometric predictors of stent thrombosis.7,8 Optical coherence tomography (OCT) is a novel high-resolution invasive coronary imaging technique that allows fast scan of long coronary segments with the possibility of assessing vessel size, atherosclerosis morphology, and stent architecture with sub-millimeter resolution that is currently 10 times higher than intravascular ultrasound. OCT could be helpful in planning and guiding the optimal treatment of complex coronary disease.9,10