The American Heart Hospital Journal


many case series have reported the feasibility and safety of a graft-coated stent for the treatment of coronary aneurysm during a primary PCI.19


CAE, despite intravascular ultrasound (IVUS) guidance, is related to an inability to detect a healthy/normal segment in which a stent can be safely implanted;20


Figure 3: Immediate Angiography and Long-term Computed Tomography Results


Conversely, the presence of diffuse AB for this reason we


decided to perform a plain old balloon angioplasty with ‘kissing’ technique (double-balloon inflation) to provide a better thrombus remodeling at the bifurcation carena.


Owing to the large arterial size and to the massive intracoronary thrombosis, current reperfusion therapies (thrombolysis, primary stenting, manual thrombectomy), if used alone, cannot prevent the development of distal embolization and the ‘no reflow phenomenon.’ Therefore, a dethrombosis multistrategy is needed, as demonstrated in this case report. The transradial approach, as known, is associated with a lower rate of bleeding complications affecting the prognosis in patients with an acute coronary syndrome. This case report demonstrates the feasibility and efficacy of a sequential dethrombosis multistrategy (thrombus aspiration, filter wire, abciximab intracoronary infusion) with a 6 French guiding catheter transradial approach. Contrary to atherosclerotic coronary artery disease, there are poor data adequately addressing the medical management of coronary artery ectasia, the viewpoints about use of long-term anticoagulation are


1. Henriques JP, Zijlstra F, Ottervanger JO, et al., Incidence and clinical significance of distal embolization during primary angioplasty for acute myocardial infarction, Eur Heart J, 2001;141:353–9.


2. Grines CL, Cox DA, Stone GW, et al., Coronary angioplasty with or without stent implantation for acute myocardial infarction, N Engl J Med, 1999;341:1949–56.


3. Petronio AS, Rovai D, Musumeci G, et al., Effects of abiciximab on microvascular integrity and left ventricular functional recovery in patients with acute infarction treated by primary coronary angioplasty, Eur Heart J, 2003;24:67–76.


4. Burzotta F, Testa L, Giannico F, et al., Adjunctive devices in primary or rescue PCI: a meta-analysis of randomized trials, Int J Cardiol, 2008;123:313–21.


5. Svilaas T, Vlaar PJ, van der Horst IC, et al., Thrombus aspiration during primary percutaneous coronary intervention, N Engl J Med, 2008;358:557–67.


6. Vlaar PJ, Svilaas T, Vlaar PJ, et al., Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study. (TAPAS): a 1 year follow-up study, Lancet, 2008;371:1915–20.


7. Burzotta F, Trani C, Romagnoli E, et al., Feasibility of sequential thrombus aspiration and filter distal protection in the management of very high thrombus burden lesions, J Invasive Cardiol, 2007;19(8):317–23.


8. Markis JE, Joffe CD, Cohn PF, et al., Clinical significance of coronary arterial ectasia, Am J Cardiol, 1976;37(2):217–22.


9. Bernard F, Revel F, Monsegu J, et al., Coronary vessel ectasia: Coronary artery disease with high tromboembolic risk, Ann Cardiol Angiol, 1998:47(3):160–4.


10. Katritsis DG, Zografos T, Korovesis S, et al., Antiendothelial cell antibodies in patients with coronary artery ectasia, Coron Artery Dis, 2010;21(6):352–6.


Summer 2011


Case Report


A: Final post-procedural angiographic result. B: One-year coronary CT angiography follow-up result.


contradictory and optimal antithrombotic treatment guidelines have not been well established. The use of post-procedural dual antiplatelet regimen (aspirin plus clopidogrel) for a follow-up period of one year was clinically and angiographically effective confirming in this case report the anti-thrombotic preventive role of antiplatelet therapy alone. As with patients with other coronary anomalies or coronary artery bypass grafts, the coronary CT angiography is a valid and suitable alternative to coronary angiography, for performing the angiographic follow-up of patients with coronary ectasia. n


11. Akyurek O, Berkalp B, Sayin T, et al., Oral D. Altered coronary flow properties in diffuse coronary artery ectasia, Am Heart J, 2003;145:66–72.


12. Papadakis MC, Manginas A, Cotileas P, et al., Documentation of slow coronary flow by the TIMI frame count in patients with coronary ectasia, Am J Cardiol, 2001;88(9):1030–2.


13. Gulec S, Atmaca Y, Kilickap M, et al., Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia, Am J Cardiol, 2003;91(8):996–9.


14. Lamblin N, Bauters C, Hermant X, et al., Polymorphisms in the promoter regions of MMP-2, MMP-3, MMP-9 and MMP-12 genes as determinants of aneurysmal coronary artery disease, J Am Coll Cardiol, 2002;40(1):43–8.


15. Kermode AG, Thompson AJ, Tofts P, et al., Breakdown of the blood brain barrier precedes symptoms and other MRI signs of new lesions in multiple sclerosis, Brain, 1990;113:1477–89.


16. Clements JM, Cossins JA, Wells GM, et al., Matrix metalloproteinase expression during experimental autoimmune encephalomyelitis and effects of a combined matrix metalloproteinase and tumor necrosis factor-alpha inhibitor, J Neuroimmunol, 1997;74:85–94.


17. Chandler S, Miller KM, Lury J, et al., Matrixmetalloproteinases, tumor necrosis factor and multiple sclerosis: an overview, J Neuroimmunol, 1997;72:155–61.


18. Yip HK, Chen MC, Wu CJ, et al., Clinical features and outcome of coronary artery aneurysm in patients with acute myocardial infarction undergoing a primary percutaneous coronary intervention, Cardiology, 2002;98(3):132–40.


19. Burzotta F, Trani C, Romagnoli E, et al., Percutaneous treatment of a large coronary aneurysm using the self-expandable symbiot PTFE-covered stent, Chest, 2004;126(2):644–5.


20. Ochiai M, Yamagushi T, Tagushi J, et al., Angioplasty of stenoses adjacent to aneurysmal coronary artery disease, Jpn Heart J, 1990;31:749–57.


Diffuse Coronary Ectasia Complicated by Myocardial Infarction 51


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