Second-Generation Drug-Eluting Stents Fully Covering a CAA and Stenosis Lesion Found to Be Safe

The implantation of a second-generation drug-eluting stent (DES) fully covering a coronary artery aneurysm (CAA) and stenosis lesion was found to be safe and effective, according to a retrospective study published in Angiology.

Patients (n=33) with a CAA with stenosis lesion >60% who had a coronary angiography performed between 2014 and 2017 at Nanjing First Hospital in China were included. CAAs were divided into saccular aneurysms (transverse diameter superior to its length) and fusiform aneurysms (transverse diameter shorter than its length). All patients received a second-generation DES and were monitored for 1 year.

In this cohort (mean age, 65.8±11.1 years; 69.7% men), 42.4% of patients were smokers, 81.8% had hypertension, 36.4% had hyperlipidemia, 54.5% had unstable angina pectoris, and 97.0% were on statins. At baseline, mean values in the cohort were the following: white blood cell count was 7.00±2.20 x 10⁹/L; neutrophil count, 4.86±2.14 x 10⁹/L; creatine kinase-MB, 52.9±88.8 U/L; cardiac troponin-I, 6.43±13.87 ng/mL; and high-sensitivity C-reactive protein, 6.3±6.5 mg/mL.

Most CAAs (75.8%) were located in the left anterior descending artery and the CAA expansion ratio was 1.85±0.53 mm. The following parameters were found to be improved after vs before DES implantation: minimal luminal diameter (0.85±0.27 mm vs 2.78±0.38 mm, respectively; P =.00), diameter stenosis (69.72%±8.82% vs 4.04%±2.87%, respectively; P =.00), and thrombolysis in myocardial infarction flow grade (2.67±0.88 vs 5.08±1.85, respectively; P =.035).

CAA diameter (5.08±1.85 mm vs 3.68±0.62 mm, respectively; P =0.00) and CAA length (8.32±3.59 mm vs 4.47±3.13 mm, respectively; P =0.00) were reduced and CAA resolution ratio was increased (3.25%±5.42% vs 48.36%±51.15%, respectively; P =0.00) at the 1-year follow-up compared with immediately after PCI.

No significant improvement in proximal (3.25±0.47 mm vs 3.37±0.46, respectively; P =.329; vs 3.42±0.46 mm, respectively; P =.638) or distal (2.79±0.38 mm vs 2.90±0.40 mm, respectively; P =.260; vs 2.93±0.44 mm, respectively; P =.764) reference vessel diameters were observed before the procedure, immediately after, or at the 1 year follow-up, respectively.

No cardiac deaths, myocardial infarctions, or revascularizations were observed among participants.

Study limitations include the small sample size.

“Slow blood flow and disorder in CAA lumen is an important factor for thrombus formation, which means that if a CAA is shrunk, the risk of acute [myocardial infarction] and even cardiac death may be significantly reduced. Therefore, the optimal treatment for these patients is to safely and efficiently reduce CAA size and expand moderate or severe stenosis lesion,” noted the study authors.

Reference

Wu Z, Xu C, You W, et al. Outcomes in patients fully covered with coronary artery aneurysm and stenosis lesion by second generation drug-eluting stents after 1 year. Angiology. 2020;3319720944346. doi:10.1177/0003319720944346