sirolimus and Aneurysm--False

Coronary pseudoaneurysm is a rare complication of percutaneous coronary intervention with a drug-eluting stent. Neither precise incidence of the complication has been known, nor there has been any established therapeutic approach for it. A 69-years-old male with effort angina underwent percutaneous coronary intervention to his left main coronary artery (LMCA). After pre-dilatation with a balloon, Endeavor zotarolimus-eluting stent (E-ZES) was successfully implanted into the lesion that extended from his LMCA to left anterior descending artery. At 6 months after stenting, coronary angiography (CAG) and intravascular ultrasound (IVUS) revealed coronary pseudoaneurysm at the stented segment. Follow-up CAG at 13 months after stenting showed the spontaneous and complete resolution of the pseudoaneurysm. Subsequent IVUS, optical coherence tomography, and coronary angioscopy visualized complete neointimal coverage of stent struts. This is the first case report of E-ZES-related pseudoaneurysm with relatively rapid resolution. Our patient suggests that E-ZES might incidentally contribute to this favorable outcome.

Topics: Aged; Aneurysm, False; Drug-Eluting Stents; Humans; Immunosuppressive Agents; Male; Sirolimus

We report the case of a 69-year-old male whose left circumflex coronary artery was perforated immediately after implantation of an Endeavor zotarolimus-eluting stent (E-ZES). Despite successful hemostasis by long balloon inflation, a coronary pseudoaneurysm remained at the E-ZES-implanted segment. Coronary angiography performed one year after the coronary perforation showed the pseudoaneurysm had disappeared. Simultaneous optical coherence tomography and coronary angioscopy revealed that stent struts of the E-ZES were fully covered with thick neointima. This is the first case report of a relatively rapid healing process for an E-ZES-related coronary pseudoaneurysm.

Topics: Aged; Aneurysm, False; Angioscopy; Antibiotics, Antineoplastic; Blood Vessel Prosthesis Implantation; Coronary Vessels; Drug-Eluting Stents; Humans; Male; Sirolimus; Tomography, Optical Coherence; Wound Healing

Coronary stent infection is exceedingly rare, with only 23 reported cases. We present a patient with an everolimus-coated stent infection that led to an infected pseudoaneurysm in the left anterior descending artery. Medical therapy failed and the patient underwent emergent surgical intervention; however, he died of multiorgan failure after the operation.

Topics: Aged; Aneurysm, False; Angioplasty, Balloon, Coronary; Bacteremia; Cardiac Output, Low; Coronary Stenosis; Everolimus; Fatal Outcome; Humans; Male; Prosthesis-Related Infections; Reoperation; Sirolimus; Staphylococcal Infections; Stents

Coronary pseudoaneurysms following implantation of drug-eluting stents, although rare, are not unknown. Nearly all such cases have been reported in patients with sirolimus or paclitaxel polymer-based stents. We describe a case of coronary pseudoaneurysm developing with a non-polymer-based drug-eluting stent in a 50-year-old man who was successfully managed by coronary artery bypass grafting.

Topics: Aneurysm, False; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Aneurysm; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Drug-Eluting Stents; Humans; Male; Middle Aged; Prosthesis Design; Sirolimus; Treatment Outcome

Tumor progression before orthotopic liver transplantation (OLT) is the main cause of dropouts from waiting lists among patients with hepatocellular carcinoma (HCC). Performing a porto-caval shunt (PCS) before parenchymal liver transection has the potential to allow an extended hepatectomy in patients with decompensated liver cirrhosis, reducing portal hyperflow and therefore the sinusoidal shear-stress on the remnant liver. We report the case of a 59-year-old man affected by hepatitis C virus (HCV)-related decompensated liver cirrhosis (Child Pugh score presentation, C-10; Model for End Stage Liver Disease score, 18) and HCC (2 lesions of 2 and 2.8 cm). The patient began the evaluation to join the OLT waiting list, but, in the 3 months required to complete the evaluation, he developed tumor progression: 3 HCC lesions, the largest 1 with a diameter of about 4.4 cm. These findings excluded transplantation criteria and the patient was referred to our center. After appropriate preoperative studies, the patient underwent a major liver resection (trisegmentectomy) after side-to-side PCS by interposition of an iliac vein graft from a cadaveric donor. The patient overcame the worsened severity of cirrhosis. After 6 months of follow-up, he developed 2 other HCC nodules. He was then included on the waiting list at our center, undergoing OLT from a cadaveric donor at 8 months after salvage treatment. At 36 months after OLT, he is alive and free from HCC recurrence. Associating a partial side-to-side PCS with hepatic resection may represent a potential salvage therapy for patients with decompensated cirrhosis and HCC progression beyond listing criteria for OLT.

Topics: Adult; Alcoholism; Aneurysm, False; Antibiotics, Antineoplastic; Carcinoma, Hepatocellular; Embolization, Therapeutic; Female; Humans; Hydrothorax; Immunosuppressive Agents; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic; Sirolimus; Treatment Outcome; Varicose Veins

Coronary artery stent infection is a rare complication of percutaneous intervention. We report a case of fulminant coronary stent infection with Staphylococcus aureus presenting as a pseudoaneurysm of the left circumflex artery following repeated implantation of drug-eluting stents in the setting of multiple episodes of recurrent in-stent restenosis. We speculate that sirolimus- and paclitaxel-eluting stents may be more likely to predispose to infection than bare metal stents because of their immunomodulating and antiproliferative effects.

Topics: Aged; Aneurysm, False; Aneurysm, Infected; Blood Vessel Prosthesis Implantation; Cardiovascular Agents; Cell Proliferation; Coronary Restenosis; Fatal Outcome; Humans; Immunosuppressive Agents; Male; Paclitaxel; Prosthesis-Related Infections; Sirolimus; Staphylococcal Infections; Staphylococcus aureus; Stents