A Case of Giant Right Coronary Artery Aneurysm after DES Implantation

Md Abdul Kader Akanda, Mohammad Ullah, Md Ataur Rahman, Md Sarwar Alam, Amiruzzaman Khan

Introduction of Drug-Eluting Stent (DES) proved to be an important step forward in reducing rates of restenosis and target lesion revascularization after percutaneous coronary intervention, but at the same time potentially causing serious complications. One of the rare complications of DES is coronary artery aneurysm with a reported incidence of 0.3% to 6.0%, and most “aneurysms” are in fact pseudo aneurysms rather than true aneurysms.1,2 Residual dissection and deep arterial wall injury (rupture or resection of the vessel media) caused by oversized balloons or stents, high-pressure balloon inflations,
atherectomy, and laser angioplasty have all been associated with coronary artery aneurysms after coronary intervention.3 Drug-eluting stents (DES), which locally elute anti-proliferative drugs, can dramatically inhibit neointimal growth, thereby suppressing restenosis,[4,5] but at the same time potentially causing coronary aneurysms due to other mechanisms, such as delayed reendothelialization, inflammatory changes of the medial wall, and hypersensitivity reactions.6,7 These findings may be due to delayed healing secondary to the anti-proliferative action of the eluted drug, cell necrosis and/or apoptosis from the antimetabolite effect of the drug, and hypersensitivity reactions to the drug/polymer mixture on the DES.6,8 However, the true
incidence, clinical course, and treatment of coronary artery aneurysms after DES implantation remain largely unknown. Treatment of CAA is somewhat controversial, and there is no consensus on the modality of treatment in a given clinical situation. We report a case of giant CAA after DES implantation presenting with fever, which was treated by surgery.

Case report:
A 35 year old diabetic, hypertensive male was admitted in SSMC & Mitford hospital with high grade fever associated with chill and rigor. Patient underwent coronary angiogram and angioplasty of RCA following acute inferior wall Myocardial infarction (AMI) four months back. Documents related to angiogram and angioplasty was not available. On query he gave history of admission for a febrile episode of 10 days after PCI and was hospitalized and treated with parenteral