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Occurrence of a slowly growing pseudoaneurysm and restenosis in coronary artery following primary percutaneous coronary intervention in a patient with acute myocardial infarction.

A 43-year-old male patient was admitted to our coronary care unit with the diagnosis of anterior AMI. He had undergone successful balloon angioplasty to the mid LAD 20 months ago (Fig.1A). Coronary angiography (CA) was immediately performed and showed total occlusion in the proximal LAD (Fig.1B) and severe stenosis in the circumflex artery (Cx). The occlusion site was dilated with a 2.5x20mm balloon but postprocedure there was a localized dissection (Fig. 1C) and a stent (3.0x18mm) was successfully implanted. He developed coronary spasm and localized dissection at the distal of the stent after PCI (Fig. 1D), and a second stent (3.0x12mm) was successfully deployed to the distal of the first stent. He remained asymptomatic and echocardiography showed no pericardial effusion. Two weeks later, he started developing chest pain despite adequate medications. Coronary angiography showed a focal crater appearance (6x4.5mm) in the proximal end of the first stent in LAD (Fig. 2A). Figures 2B and 2C demonstrate contrast flow within a tract leading from the artery lumen to the formation consistent with “pseudoaneurysm neck”, and Figure 2D shows the aneurysm formation. A decision for follow-up of the aneurysm was made. A stent (2.5x15.0mm) was successfully implanted to the stenotic site in Cx. After six weeks, although he was asymptomatic, CA was performed and there was a slight enlargement in the aneurysm (Fig. 3A). About 6 months later, he was readmitted to our hospital because he had angina during exercise. Coronary angiography showed an 80% stenosis in the just proximal end of the aneurysm and it was approximately measured to be 6x6 mm (Fig. 3B). A Jostent coronary graft stent (3.5x16.0mm) was successfully deployed to restenotic and aneurysmal site (Fig. 3C). About 4 years later, CA was performed because he started developing progressive angina Occurrence of a slowly growing pseudoaneurysm and restenosis in coronary artery following primary percutaneous coronary intervention in a patient with acute myocardial infarction