AI Article Synopsis
- Coronary artery aneurysms (CAA) occur in about 5% of patients during coronary angiography, and while covered stents have been used for treatment, there’s limited evidence on their effectiveness and safety.
- A systematic review of 63 case reports and 3 case series included data from 81 patients, revealing a high procedural success rate of 95.1%, with the majority of aneurysms located in native coronary arteries.
- Although the use of covered stents appears generally effective and reasonably safe, there is a notable 26.2% rate of major adverse cardiovascular events, primarily due to increased target lesion revascularization, highlighting a need for further research to optimize patient selection for this treatment.
Article Abstract
Background: Coronary artery aneurysms (CAA) are reported in up to 5% of patients undergoing coronary angiography. Treatment of CAAs with covered stents has been reported in several case reports, however there is limited evidence available on the effectiveness and safety of this interventional practice.
Purpose: To evaluate the current practice and outcomes of elective treatment of coronary artery aneurysms with covered stents.
Methods: We conducted a systematic review of published case reports and case series of patients presenting with CAA that have been treated with covered stents in a non-emergency setting.
Results: A total of 63 case reports and 3 case series were included in the final analysis comprising data from 81 patients. The treated CAA was situated in a native coronary artery in 92.6%, and in a saphenous vein graft in 7.4%. Procedural success was achieved in 95.1%. The types of stents used were mainly polytetrafluoroethylene (75.3%) and Papyrus (11.1%). In 11.0% of cases additional abluminal drug eluting stents (DES) and in 6.8% additional adluminal DES were implanted. After a mean follow up of 13.4 months overall major adverse cardiovascular events (MACE), mortality, myocardial infarction, stroke, stent thrombosis and target lesion revascularization were reported in 26.2, 0.0, 7.6, 0.0, 4.6 and 18.5% of cases, respectively.
Conclusions: The use of covered stents for elective treatment of CAA appears to be effective and reasonably safe. Nevertheless, it is associated with higher MACE rate, driven mainly by higher target lesion revascularization. Further studies, particularly in form of randomized trials and controlled registries are warranted to identify patients who might profit the most from this procedure.
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| http://dx.doi.org/10.1016/j.carrev.2021.05.018 | DOI Listing |
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