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      Progressive growth of coronary aneurysms after bioresorbable vascular scaffold implantation: Successful treatment with OCT‐guided exclusion using covered stents

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          Abstract

          The development and progressive enlargement over time of multiple saccular coronary artery aneurysms (CAA) after implantation of everolimus‐eluting stent and bioresorbable vascular scaffolds (BVS) have been reported. CAA was successfully excluded by two overlapped covered stents expanded inside a long metallic drug‐eluting stent to avoid dislodgment at the overlap point. Optical coherence tomography (OCT) was repeatedly performed to monitor CAA expansion and to guide treatment through precise measurement of aneurysm length and vessel size at the landing zone. At 10‐month follow‐up, coronary computed tomography angiography showed persistent CAA exclusion. To the best of our knowledge, this is the first report of this technique to exclude a long CCA segment.

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          Most cited references15

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          Management of Coronary Artery Aneurysms

          Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of largescale outcome data on their various treatment modalities, coronary artery aneurysms and coronary ectasia pose a challenge to the managing clinician. This paper aims to provide a succinct review of aneurysmal coronary disease, with a special emphasis on the challenges associated with its interventional treatment.
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            Coronary artery aneurysms after drug-eluting stent implantation.

            Drug-eluting stents (DES), which locally elute antiproliferative drugs, can dramatically inhibit neointimal growth. However, several pathological studies have indicated that DES may delay healing after vascular injury, and DES implantation may be theoretically associated with a risk of coronary artery aneurysm formation. Coronary aneurysms have been reported from 3 days to up to 4 years after DES implantation procedures, with varying clinical presentations. The incidence of coronary artery aneurysms after DES implantation is low within the first 9 months, with a reported incidence of 0.2% to 2.3%, a rate similar to that reported after bare-metal stent (BMS) implantation (0.3% to 3.9%) in the DES versus BMS randomized trials. However, the true incidence of coronary aneurysms in an unselected patient population is still largely unknown. This article reviews the published literature on coronary artery aneurysms specifically relating to DES.
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              Coronary evaginations and peri-scaffold aneurysms following implantation of bioresorbable scaffolds: incidence, outcome, and optical coherence tomography analysis of possible mechanisms.

              Peri-stent coronary evaginations may disturb flow and have been proposed as possible risk factor for late stent thrombosis. We describe incidence, predictors, and possible mechanisms of coronary evaginations 12 months after implantation of bioresorbable vascular scaffolds (BVS).
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                Author and article information

                Contributors
                franco.fabbiocchi@ccfm.it
                Journal
                Catheter Cardiovasc Interv
                Catheter Cardiovasc Interv
                10.1002/(ISSN)1522-726X
                CCD
                Catheterization and Cardiovascular Interventions
                John Wiley & Sons, Inc. (Hoboken, USA )
                1522-1946
                1522-726X
                03 August 2020
                01 April 2021
                : 97
                : 5 ( doiID: 10.1002/ccd.v97.5 )
                : E676-E679
                Affiliations
                [ 1 ] Centro Cardiologico Monzino, IRCCS Milan Italy
                [ 2 ] Department of Biomedical and Clinical Sciences “Luigi Sacco” University of Milan Milan Italy
                Author notes
                [*] [* ] Correspondence

                Franco Fabbiocchi, MD, Via C. Parea 4, 20138 Milan, Italy.

                Email: franco.fabbiocchi@ 123456ccfm.it

                Author information
                https://orcid.org/0000-0001-9452-1664
                Article
                CCD29193
                10.1002/ccd.29193
                8246866
                32744772
                24972285-9b42-4e02-9232-4d089b326867
                © 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 08 July 2020
                : 06 April 2020
                : 19 July 2020
                Page count
                Figures: 2, Tables: 0, Pages: 4, Words: 2446
                Categories
                Case Report
                Coronary Artery Disease
                Case Reports
                Custom metadata
                2.0
                April 1, 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:01.07.2021

                coronary imaging,percutaneous intervention,vascular ectasia

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