A new study from Spain is raising concerns about the possible dangers of coronary aneurysms following DES implantation. The study by Alfonso et al is published in the Journal of the American College of Cariology.
In the study, nearly 1,200 consecutive patients underwent late angiographic evaluation after DES implantation. Coronary aneurysms were found in 15 (1.25%) of patients. Two of the patients had acute MI as a result of DES thrombosis, 4 patients had ACS. Nine patients were asympatomatic, but one subsequently died of cardiogenic shock after MI related to the aneurysm. The complications were related to discontinuation of dual antiplatelet therapy, according to the authors.
The authors conclude: “Development of CAN [coronary aneurysm] after DES implantation is rare. This unique phenomenon is usually detected in asymptomatic patients and has a benign clinical course under a dual antiplatelet regimen. However, angiographic CAN may be associated with DES restenosis, and more importantly, with DES thrombosis. Intravascular ultrasound seems to beuseful for identifying patients at higher risk for complications.
David Kandzari provided the following comment to CardioBrief: “Actually, acquired late incomplete apposition (ie, “aneurysm” formation, if the vessel remodeling is large enough and qualifies as an aneurysm) is a longstanding issue that has been identified in about 8% of unselected patients when angiographic and IVUS follow up has been performed, ie, typically within the context of clinical trials. It may be more common, however, in situations in which a DES is placed in the setting of deep wall vascular injury (ie, AMI, CTO recanalization, directional atherectomy). The mechanism is expansive, positive remodeling of the vessel away from the stents, and it is most common with Cypher and Taxus (and maybe Xience, there’s just too little Xience data out there), but not with Endeavor. The belief is that it may be a biocompatibility/hypersensitivity issue with the polymer, since it is identified after the drug is exhausted from the stent.”
“Intutitively, it doesn’t seem like a good thing for your artery to be growing away from a stent and leaving a stent malapposed, but the question has been whether it is clinically associated with adverse events, and the data has been inconsistent. One study in Circulation last year by Windecker made the association, and it seems this one has as well. So it’s not really a new finding. Still, doesn’t seem to be a major driver against DES, partly because we typically don’t do follow up IVUS/angiography to see its real occurrence. If you don’t look, you’ll never see it!”
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