Author + information
- Received March 7, 2014
- Revision received March 19, 2014
- Accepted March 21, 2014
- Published online October 1, 2014.
- Gianluca Pontone, MD, PhD∗∗ (, )
- Laura Cavallotti, MD∗,
- Erika Bertella, MD∗,
- Daniele Andreini, MD, PhD∗,†,
- Alessandro Lualdi, MD∗,† and
- Francesco Alamanni, MD∗,†
- ∗Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- †Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- ↵∗Reprint requests and correspondence:
Dr. Gianluca Pontone, Centro Cardiologico Monzino, Via C. Parea 4, 20138 Milan, Italy.
Coronary pseudoaneurysms (PsA) have rarely been described as late complications of stent implantation (1,2). A 65-year-old man, with previous history of coronary artery bypass graft with left internal mammary artery on left anterior descending artery 8 years before and recent inferior ST-segment elevation myocardial infarction treated by proximal right coronary artery (RCA) stent implantation, was referred to our hospital for atypical chest pain. During the physical examination, the patient experienced a left parasternal pulsing cutaneous fistula, but the blood tests did not show any significant abnormalities and an electrocardiogram was unchanged. The patient underwent computed tomography showing a giant PsA of RCA due to stent rupture (Figures 1A to 1C) with parasternal cutaneous fistula that was confirmed by invasive coronary angiography (Figure 1D, Online Video 1). The patient was treated in a hybrid room with proximal RCA balloon positioning to avoid cardiac tamponade in case of PsA rupture followed by PsA resection (Figure 1E) with removal of stent scraps. A proximal and distal RCA ligation was performed with saphenous vein graft between ascending aorta and distal RCA. The procedure was successful as confirmed by invasive coronary angiography (Figures 1F and 1G, Online Videos 2 and 3). Tissue cultures were negative and pathological examination confirms the presence of giant PsA. The post-operative recovery was uneventful, and the patient was therefore discharged. At 6 months’ follow-up, the patient was doing well and was without complications. Recent literature showed that a conservative therapeutic strategy has excellent long-term prognosis (3). Alternatively, coronary artery bypass graft is the most common treatment. To the best of our knowledge, this is the first case of PsA as a late complication of stent rupture presenting as parasternal cutaneous pulsing fistula in a clinically stable patient treated by a hybrid surgical and percutaneous approach.
For accompanying videos, please see the online version of this paper.
The authors have reported that they have no relationships relevant to this paper to disclose. Drs. Pontone and Cavallotti contributed equally to this work.
- Received March 7, 2014.
- Revision received March 19, 2014.
- Accepted March 21, 2014.
- American College of Cardiology Foundation