Chonnam Med J.  2012 Dec;48(3):185-189. 10.4068/cmj.2012.48.3.185.

Two Different Successful Angioplasty Methods in Patients with Stenotic Coronary Artery Ectasia

• Oh SK
• Rha SW
• Kook H
• Kim DH
• Ho SY
• Kim SH
• Choi CU
• Oh DJ

• KMID: 2048811
• DOI: http://doi.org/10.4068/cmj.2012.48.3.185

Abstract

There is no current guideline for percutaneous coronary angioplasty in stenotic ectatic coronary arteries because of the heterogeneity of the coronary artery morphology. We report two successful angioplasty cases in coronary artery ectasia with different clinical scenarios. One case showed atherosclerotic stenosis in the ectatic portion of the right coronary artery that was aggravated after a coronary artery bypass graft. In this case, balloon angioplasty alone without stenting showed acceptable results at the 6-month follow-up coronary angiography. In the other case, we used a peripheral artery balloon and stent for stenosis in the ectatic portion of a large coronary artery. Six-month follow-up coronary angiography showed excellent patency of the previously implanted peripheral stent.

Keyword

Angioplasty; Balloon; Coronary

MeSH Terms

Angioplasty
Angioplasty, Balloon
Arteries
Constriction, Pathologic
Coronary Angiography
Coronary Artery Bypass
Coronary Vessels
Dilatation, Pathologic
Follow-Up Studies
Humans
Population Characteristics
Stents
Transplants

Figure

• 

  FIG. 1 Computed tomography (CT) and invasive angiography showing the patient's abdominal aortic aneurysm in the ascending aorta and significant stenosis in the right ectatic coronary artery. The CT aortogram (A) shows both the abdominal aortic aneurysm (red arrow) and the ascending aortic aneurysm (white arrow). Coronary CT angiography (B) and right coronary angiography (C) show the focal severe stenotic lesion (white arrows) in the mid portion of the ectatic right coronary artery.

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  FIG. 2 Follow-up coronary CT angiography after 7 months showing two focal sites of eccentric significant stenosis (white arrow in A and red arrow in B) with soft plaque in the mid right coronary artery.

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  FIG. 3 Coronary angiography at baseline, during percutaneous coronary angioplasty, after percutaneous coronary angioplasty, and at follow-up. (A) Coronary angiography showing moderate tubular concentric stenosis in the proximal RCA and severe discrete concentric stenosis in the mid RCA with ectatic change. (B) Sequential balloon dilation with Avita 3.0×15 mm and Mercury 4.0×20 mm balloons was performed in the mid right coronary artery. (C) Coronary angiography after balloon angioplasty showing a well expanded stenotic lesion without flow limitation. (D) Follow-up coronary angiography after 6 months showing acceptable patency at the previous balloon angioplasty sites (white arrow).

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  FIG. 4 Coronary angiography and intravascular ultrasound (IVUS) image showing before, during, and after the percutaneous coronary angioplasty. (A) Baseline coronary angioplasty showing severe tubular eccentric stenosis (white arrow) in the mid left circumflex artery with ectatic change. (B) Coronary angiography showing deployment of a Genesis 6.0×24 mm stent (white arrow). (C) Coronary angiography showing a well expanded stent without flow limitation. (D) IVUS showing eccentric plaque burden (white arrow) from the 5 o'clock to the 7 o'clock direction. The reference vessel diameter just distal to the lesion was 6.2×6.8 mm on IVUS measurement. (E) Post-stenting IVUS showed good apposition and expansion of the stent.

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  FIG. 5 Follow-up coronary angiography at 6 months showing the previous stent to be patent without significant in-stent restenosis.

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