Percutaneous Treatment of a Giant Coronary Aneurysm Using a Greft Stent in a Patient with Systemic Lupus Erythematosus

Year 2018, Volume: 71 Issue: 1, 69 - 72, 16.10.2018

Hüseyin Göksülük , Yusuf Atmaca , Başar Candemir , Demet Menekşe Gerede Uludağ , Onur Yıldırım , Çetin Erol

Abstract

Coronary artery aneurysm/ectasia (CAE) is defined as a dilatation of a coronary artery segment to more than 1.5-fold normal size in diameter. The leading etiologic factor of CAE is atherosclerotic coronary artery disease, but it can be seen rarely secondary to inflammatory diseases in romatological diseases (e.g. Kawasaki disease,
Takayasu’s arteritis, Systemic Lupus Erythematosus (SLE), rheumatoid arthritis). We present here in a giant coronary aneurysm, possible etiologic causes and treatment in a patient with SLE who had a previous coronary intervention. Treatment was performed successfully with a covered stent. We thought that the
aneurysm was developed secondary to the drug eluting stent that was previously implanted while SLE was in remission. This case report emphasizes that coronary artery disease should be considered in SLE patients who do not have traditional risk factors for coronary artery disease.

Keywords

Coronary Aneurysm , Systemic Lupus Erythematosus , Graft Stent

Ethical Statement

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Thanks

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Sistemik Lupus Eritematozus Olan Bir Hastada Dev Sakküler Koroner Anevrizmanin Greft Stent İle Perkütan Tedavisi*

Abstract

Koroner arter anevrizması/ektazisi (KAE) koroner arter segmentinin normal damar çapının 1.5 katından fazla genișlemesi olarak tanımlanır. En sık etyolojik nedeni aterosklerotik koroner arter hastalığıdır; fakat, romatizmal hastalıklarda (Kawasaki hastalığı, Takayasu arteriti, sistemik lupus eritematozus (SLE), Romatoid artrit gibi) inflamasyona sekonder nadiren görülebilir. Biz burada daha önce koroner arter girișim hikayesi ve SLE tanısı olan bir hastada, dev koroner arter anevrizmasını, olası etyolojik nedenini ve tedavisini sunmayı amaçladık. Tedavide, anevrizma greft stent ile kapatıldı. Hastada, klinik bulgulara ve laboratuvar verilerine göre SLE remisyonda idi. Bu nedenle, anevrizmanın daha önce takılan ilaç salınımlı stente sekonder geliștiği düșünüldü. Bu vaka sunumu ile, koroner arter hastalığı geleneksel risk faktörleri olmayan SLE hastalarında, koroner arter hastalığının düșünülmesi gerektiği vurgulanmıștır

Keywords

Koroner Anevrizma , Sistemik Lupus Eritematozus , Greft Stent

Project Number

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References

• 1. Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis 1997; 40: 77-84.
• 2. Nagao T, Ito K, Tsuboi H et al. Rare complications of systemic lupus erythematosus. Intern Med. 2012; 51: 3101-3102.
• 3. Moder KG, Miller TD, Tazelaar HD. Cardiac involvement in systemic lupus erythematosus. Mayo Clin Proc 1999; 74: 275- 284.
• 4. Petri M, Spence D, Bone LR et al. Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: Prevalence, recognition by patients, and preventive practices. Medicine 1992; 71: 291-302.
• 5. Burkley BH, Roberts WC. The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: a study of 36 necropsy patients. Am J Med 1975;58:242–264.
• 6. Korbet SM, Schwartz MM, Lewis EJ. Immune complex deposition and coronary vasculitis in systemic lupus erythematosus. Report of two cases. Am J Med. 1984;77:141-146.
• 7. Suzuki H, Fujigaki Y, Mori M. Giant coronary aneurysm in a patient with systemic lupus erythematosus. Intern Med. 2009;48: 1407-1412.
• 8. Swaye PS, Fisher LD, Litwin P: Aneurysmal coronary artery disease. Circulation 1983; 67: 134-138
• 9. Robertson T, Fisher L: Prognostic significance of coronary artery aneurysm and ectasia in the coronary artery surgery study (CASS) registry, in Shulman ST (ed): Kawasaki disease: Proceedings of the Second International Kawasaki Symposium. New York, NY, A.R. Liss, 1987; 325-339.
• 10. Aqel RA, Zoghbi GJ, Iskandrian A: Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: A review. Echocardiography 2004;21:175–182
• 11. Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia: its prevalence and clinical significance in 4993 patients. Br Heart J. 1985; 54: 392–395.
• 12. Villines TC, Avedissian LS, Elgin EE. Diffuse nonatherosclerotic coronary aneurysms. Cardiol Rev. 2005; 13: 309 – 311.
• 13. Korbet SM, Schwartz MM, Lewis EJ. Immune complex deposition and coronary vasculitis in systemic lupus erythematosus. Am J Med 1984; 77: 141–146.
• 14. Farb A, Heller PF, Shroff S. Pathological analysis of local delivery of paclitaxel via a polymer-coated stent. Circulation 2001; 104: 473–479.
• 15. Heldman AW, Cheng L, Jenkins GM. Paclitaxel stent coating inhibits neointimal hyperplasia at 4 weeks in a porcine model of coronary restenosis. Circulation 2001; 103: 2289–2295.
• 16. Van der Giessen WJ, Lincoff M, Schwartz RS. Marked inflammatory sequelae to implantation of biodegradable and nonbiodegradable polymers in porcine coronary arteries. Circulation 1996; 94: 1690–1697.
• 17. Curcio A, Torella D, Cuda G. Effect of stent coating alone on in vitro vascular smooth muscle cell proliferation and apoptosis. Am J Physiol Heart Circ Physiol 2004; 286: H902–H908.
• 18. Wilson VE, Eck SL, Bates ER. Evaluation and treatment of acute myocardial infarction complicating systemic lupus erythematosus. Chest 1992; 101: 420-424.