A Case of Coronary Artery Aneurysm Occurring After Drug-Coated Balloon Intervention for De Novo Chronic Total Occlusion

Abstract

Drug-coated balloons (DCBs) have been proposed as a viable alternative to drug-eluting stents (DES) for managing chronic total occlusion (CTO), reducing adverse reactions associated with DES. However, adverse events after DCB treatment are rarely reported. We present a case of coronary artery aneurysm (CAA) formation after DCB treatment. A 55-year-old active smoker presented with exertional chest pain and positive ischemic response on the exercise stress test. Diagnostic coronary angiography revealed CTO in the mid-left anterior descending (mid-LAD) coronary artery with collateral circulation arising from the contralateral side. The patient underwent DCB treatment using a paclitaxel-coated balloon after predilatation with a noncutting balloon and a semi-compliant balloon. The final angiogram showed minimal recoil, type B coronary dissection nonflow limiting, and thrombolysis in myocardial infarction (TIMI) grade 3 flow. A follow-up coronary angiogram at 6 months revealed a fusiform aneurysm at the treated lesion with DCB. Despite the asymptomatic nature of the patient, good distal flow in the LAD, and the patient achieving a TIMI grade 3 flow, a decision was made to observe and closely monitor the patient. Despite potential risks, DCB remains a viable alternative to DES in CTO cases. Our case suggests that, although CAA occurred, it did not lead to significant adverse cardiac events. Further research is needed to understand the predictors and long-term outcomes of CAA.

Keywords

drug-coated balloon - chronic total occlusion - coronary artery aneurysm

Publication History

Article published online:
07 October 2024

• References

• 1 Jun EJ, Shin E-S, Teoh E-V. et al. Clinical outcomes of drug-coated balloon treatment after successful revascularization of de novo chronic total occlusions. Front Cardiovasc Med 2022; 9: 821380
• 2 Yerasi C, Case BC, Forrestal BJ. et al. Drug-coated balloon for de novo coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol 2020; 75 (09) 1061-1073
• 3 Demopoulos VP, Olympios CD, Fakiolas CN. et al. The natural history of aneurysmal coronary artery disease. Heart 1997; 78 (02) 136-141
• 4 Bal ET, Thijs Plokker HW, van den Berg EM. et al. Predictability and prognosis of PTCA-induced coronary artery aneurysms. Cathet Cardiovasc Diagn 1991; 22 (02) 85-88
• 5 Alfonso F, Pérez-Vizcayno M-J, Ruiz M. et al. Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings. J Am Coll Cardiol 2009; 53 (22) 2053-2060
• 6 Aoki J, Kirtane A, Leon MB, Dangas G. Coronary artery aneurysms after drug-eluting stent implantation. JACC Cardiovasc Interv 2008; 1 (01) 14-21
• 7 Hakeem A, Karmali K, Larue SJ. et al. Clinical presentation and outcomes of drug-eluting stent-associated coronary aneurysms. EuroIntervention 2011; 7 (04) 487-496
• 8 Finn AV, Nakazawa G, Joner M. et al. Vascular responses to drug eluting stents: importance of delayed healing. Arterioscler Thromb Vasc Biol 2007; 27 (07) 1500-1510
• 9 Her A-Y, Shin E-S, Bang LH. et al. Drug-coated balloon treatment in coronary artery disease: recommendations from an Asia-Pacific Consensus Group. Cardiol J 2021; 28 (01) 136-149
• 10 Kleber FX, Rittger H, Bonaventura K. et al. Drug-coated balloons for treatment of coronary artery disease: updated recommendations from a consensus group. Clin Res Cardiol 2013; 102 (11) 785-797
• 11 Thim T, Milewski K, Tellez A. et al. TCT-480: biological effect on coronary restenosis of bare metal stents crimped on paclitaxel coated balloons: preliminary animal data in the porcine overstretch model. Am J Cardiol 2009; 104: 177D
• 12 Vogt F, Stein A, Rettemeier G. et al. Long-term assessment of a novel biodegradable paclitaxel-eluting coronary polylactide stent. Eur Heart J 2004; 25 (15) 1330-1340
• 13 Solomonica A, Musallam A, Roguin A. Coronary artery aneurysm following drug-coated balloon treatment. Cardiovasc Revasc Med 2015; 16 (08) 505-507
• 14 Kawsara A, Núñez Gil IJ, Alqahtani F, Moreland J, Rihal CS, Alkhouli M. Management of coronary artery aneurysms. JACC Cardiovasc Interv 2018; 11 (13) 1211-1223