sirolimus and Chest-Pain

A 34-year-old man presented to a community hospital with sudden-onset pleuritic chest pain on a background of a 12-month indolent history of progressive exertional dyspnea. He denied cough, fevers, night sweats, or weight loss. He reported some low back pain and ache. He had a history of gastroesophageal reflux and was a current smoker with a 20-pack year history. There were no known occupational or environmental exposures and there was no family history of any lung disease.

Topics: Adult; Antibiotics, Antineoplastic; Biopsy; Bone and Bones; Chest Pain; Chylothorax; Diagnosis, Differential; Humans; Immunohistochemistry; Lung Diseases; Lymphangiectasis; Male; Musculoskeletal Pain; Pleura; Pleural Effusion; Sirolimus; Thoracentesis; Tomography, X-Ray Computed; Treatment Outcome

Topics: Chest Pain; Cough; Diagnosis, Differential; Dyspnea; Female; Humans; Lung; Lung Diseases, Fungal; Lung Neoplasms; Lymphangioleiomyomatosis; Magnetic Resonance Imaging; Pneumonia, Bacterial; Pneumothorax; Radiography, Thoracic; Risk Factors; Shock; Sirolimus; Thoracostomy; Tomography, X-Ray Computed; TOR Serine-Threonine Kinases; Young Adult

Topics: Adult; Antibiotics, Antineoplastic; Chest Pain; Dyspnea; Female; Forced Expiratory Volume; Humans; Lung; Lung Neoplasms; Lymphangioleiomyomatosis; Pleurodesis; Sirolimus; Tomography, X-Ray Computed

Although previous optical coherence tomography (OCT) studies reported that restenosis tissue after implantation of a drug-eluting stent (DES) was composed of a variety of cells, the clinical significance of morphologic characteristics for in-stent neointimal tissue as assessed by OCT has not been clarified. We experienced a patient with stable angina who underwent percutaneous coronary intervention with a 2.5 × 18-mm DES implantation 6 months before the OCT examination. OCT imaging showed a mild intimal hyperplasia (39 % neointimal hyperplasia) with eccentric, heterogeneous tissue, predominantly of low signal intensity. Seventeen months after the initial procedure, OCT revealed a significant increase in percent neointimal hyperplasia of 58 %, with morphologically different intimal tissue of concentric homogeneous high intensity in the stented segments. This finding suggests that low-intensity intimal tissue morphology detected by OCT could be a morphometric predictor of late neointimal tissue growth after DES implantation.

Topics: Aged; Chest Pain; Coronary Artery Disease; Coronary Vessels; Drug-Eluting Stents; Everolimus; Humans; Hyperplasia; Male; Neointima; Percutaneous Coronary Intervention; Sirolimus; Tomography, Optical Coherence

Topics: Adult; Aortic Dissection; Cesarean Section; Chest Pain; Coronary Aneurysm; Coronary Angiography; Drug-Eluting Stents; Everolimus; Female; Follow-Up Studies; Humans; Postpartum Period; Pregnancy; Risk Assessment; Severity of Illness Index; Sirolimus; Tomography, Optical Coherence; Treatment Outcome

We present a case of a 43-year-old woman who presented with a non-ST elevation myocardial infarction. During her first cardiac catheterisation, she was diagnosed with a chronic total occlusion of the right coronary artery and a flow limiting dissection of her middle left anterior descending artery. The dissection of the left anterior descending artery was stented with two overlapping everolimus-eluting stents. There were no complications from this percutaneous coronary intervention. On the following day, the patient continued to have persistent chest pain and returned to the catheterisation laboratory. It was then found that the patient had a total occlusion of the right coronary artery secondary to dissection. This was also stented with three everolimus-eluting stents with excellent clinical and angiographic results. It is important to consider spontaneous multivessel coronary dissections which can be treated successfully with percutaneous coronary intervention.

Topics: Adult; Chest Pain; Coronary Occlusion; Coronary Vessel Anomalies; Drug-Eluting Stents; Everolimus; Female; Humans; Immunosuppressive Agents; Myocardial Infarction; Sirolimus; Vascular Diseases

Topics: Aged; Angioplasty, Balloon, Coronary; Biocompatible Materials; Chest Pain; Coronary Angiography; Coronary Vessels; Drug-Eluting Stents; Endothelium, Vascular; Everolimus; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Imaging, Three-Dimensional; Immunosuppressive Agents; Male; Myocardial Infarction; Sirolimus; Time Factors

We encountered a case of exercise-induced chest pain after the implantation of sirolimus-eluting stents (SESs). She had no history of previous chest pain, and an exercise stress test just after the implantation of the SESs was negative without any symptoms. However, six months after the implantation of the SESs, she began to experience frequent episodes of severe chest pain on effort in spite of there being no significant coronary stenosis. Interestingly, severe coronary vasoconstriction was induced by an intracoronary administration of acetylcholine, and exercise stress testing revealed positive findings with chest pain and ST-T segment depression on ECG. An intensive treatment with two types of calcium channel blockers could readily and completely abolish the exercise-induced chest pain and ST-T segment depression on the ECG. In view of these findings, we presumed that coronary microvessel dysfunction and/or exercise-induced coronary vasoconstriction leading to myocardial ischemia had appeared 6 months after the implantation of the SESs. Although the pathogenesis of this phenomenon could not be completely elucidated, the anatomical and functional abnormalities of the coronary arteries associated with the implantation of the SESs may have been one of the most important mechanisms.

Topics: Chest Pain; Drug-Eluting Stents; Exercise Tolerance; Female; Humans; Immunosuppressive Agents; Microvascular Angina; Middle Aged; Sirolimus