Angioscopy and Optical Coherence Tomography Observations after Stent-Assisted Coil Embolization for Coronary Aneurysm

Abstract

A 59-year-old male with stable angina had undergone first-generation drug-eluting stent implantation for the culprit lesion in the mid-right coronary artery. Coronary angiography 11 years after the therapy showed a complete stent fracture and aneurysm formation beside the separated stent pieces. Stent-assisted coil embolization was done to prevent rupture of the aneurysm. Third-generation drug-eluting stent was deployed over the gap between the fractured stents as a bridge, and 11 detachable coils were released into the aneurysm sac through the microcatheter. Six and a half years later, follow-up catheter examinations were performed. Optical coherence tomography showed thin tissue covering the stent struts/coils and some kind of tissue filling part of the aneurysm lumen. Angioscopy visualized yellow intima over the metals and coils as brilliant dotted lines. In addition, red and organized white thrombi were found behind the struts/coils. The metals seemed still exposed to the lumen. Coil embolization for coronary artery disease is an uncommon procedure, and then there are few reports about intravascular imaging after the treatment. We herein present angioscopic images at long-term follow-up after the coil embolization for coronary aneurysm.