Giant Coronary Artery Aneurysm after Drug-Eluting Stent (DES) Implantation: Therapeutic Challenges and Management

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. Coronary Artery Aneurysm (CAA), defined as localized dilatation of the coronary artery exceeding 50% of the reference vessel diameter is considered as very rare, with a reported incidence of 0.3-6% after percutaneous coronary intervention [1]. It is termed as giant if diameter exceeds the reference vessel diameter by four times or if the aneurysm is 8 mm or more [2]. Possible mechanisms of aneurysm formation after DES implantation are delayed reendothelialization, inflammation, and hypersensitivity reactions, apart from deep arterial wall injury (rupture or resection of the vessel media), and residual dissection [3,4]. 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 acute myocardial infarction and cardiogenic shock, which was treated by percutaneous coronary intervention using two sequential covered stents.