| 김성식¹, , 이종민¹ , 박미연¹ , 심병주¹ , 고윤석¹ , 신우승¹ , 전희경¹, 허성호² , 정욱성³ , 승기배³ |
Background/Aims: Coronary artery aneurysm, defined as a dilation of the coronary artery that exceeds 1.5 times the reference diameter of the adjacent coronary segments that are angiographically normal, has been reported after coronary angioplasty. The incidence, risk factors, and clinical meanings of drug eluting stent (DES)-related coronary artery aneurysm is not clear.
Methods: We retrospectively analyzed 243 patients with 426 lesions who had received stent insertion at Uijeongbu and Daejeon St’ Mary Hospitals between Jan. 2004 and Feb. 2008. Primary end point was defined as the composite of death, myocardial infarction, and target vessel revascularization.
Results: Thirty patients with forty lesions had neoaneurysm in their follow-up coronary angiography. Neoaneurysm group had more complex lesion (34/40 (92%) vs. 253/386 (68%), p=0.002), more CTO lesion (5/40 (13%) vs. 14/386 (4%), p=0.01), longer lesion length (35.88±15.61mm vs. 29.65±15.30mm, p=0.03), more overlapping (19/40 (49%) vs. 92/386 (24%), p=0.001), more infarct related artery (16/40 (49%) vs. 70/386 (18%), p<0.001), and more thrombus (5/40 (13%) vs. 5/386 (1.3%), p<0.001) than no neoaneurysm group. Also there was more frequently stent fracture (3/40 (7.5%) vs. 2/386 (0.5%), p=0.01) in the neoaneurysm group. In multivariate analysis, thrombus (odd ratio 29.77, 95% CI 5.95-148.93, p<0.01), stent overlapping (odd ratio 3.60, 95% CI 1.25-10.33, p=0.017), chronic total occlusion (odd ratio 5.22, 95% CI 1.12-24.45, p=0.036), and stent length (odd ratio 1.10, 95% CI 1.01-1.21, p=0.036) were independent predictors of neoaneurysm after insertion of DES. There was no significant difference in primary end point between neoaneurysm and no neoaneurysm groups (31% vs. 20% log rank p=0.196).
Conclusion: Neoaneurysm after insertion of DES had seen in the real practice. However, to know its clinical meaning, we need more large and multicenter trials.
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