|
1
|
Mutema M, Millin A, Sturla M, Karacsonyi J, Kirtane AJ, Scotti A, Latib A. Diagnosis and Management of Post-PCI Left Circumflex Coronary Artery Pseudoaneurysm. JACC Case Rep 2025; 30:103391. [PMID: 40185590 PMCID: PMC12046760 DOI: 10.1016/j.jaccas.2025.103391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/03/2025] [Accepted: 01/07/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Coronary artery pseudoaneurysms (PSAs) are a rare but potentially life-threatening complication after percutaneous coronary intervention (PCI), typically manifesting between 1 week and 4 years after the procedure. Prompt diagnosis is crucial, particularly in high-risk PSAs, which incur potential for rupture. CASE SUMMARY The authors report the case of a 77-year-old man in whom a large PSA developed in the left circumflex artery within 30 days of PCI, which was complicated by coronary perforation. During the original procedure, the perforation was sealed by a covered stent; however, anticoagulation was resumed because of atrial fibrillation 2 weeks later. The patient subsequently presented again with chest discomfort, and computed tomographic angiography showed a large PSA at the edge of the stent. Percutaneous closure using a second covered stent achieved complete PSA isolation. DISCUSSION This case aims to highlight the importance of precise stent placement, vessel wall apposition, and vigilant follow-up, particularly in patients taking intensive antithrombotic therapy.
Collapse
Affiliation(s)
- Motisola Mutema
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Antonella Millin
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA; Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Matteo Sturla
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Judit Karacsonyi
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Andrea Scotti
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Azeem Latib
- Interventional Cardiology, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
| |
Collapse
|
|
2
|
Kumar S, Sengupta S, Naqvi A, Naik H. Stab-Induced Coronary Pseudoaneurysm Managed With Stenting. JACC Case Rep 2025:103280. [PMID: 40165647 DOI: 10.1016/j.jaccas.2025.103280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 11/19/2024] [Accepted: 12/13/2024] [Indexed: 04/02/2025]
Abstract
Penetrating chest trauma, while uncommon in adolescents, can lead to severe complications, including coronary artery injuries. A 16-year-old adolescent boy presented with chest pain after a stab wound. Initial imaging revealed a hemothorax, which was treated with a chest tube. Recurrent symptoms led to further investigation, uncovering 2 pseudoaneurysms in the left anterior descending artery. The patient underwent successful coronary stenting, with marked improvement at 1-year follow-up. This case highlights the importance of multimodal imaging, including coronary computed tomography angiography, in diagnosing traumatic coronary injuries. The use of covered stents for pseudoaneurysms in the left anterior descending artery after penetrating trauma is a rare but effective treatment.
Collapse
Affiliation(s)
- Sant Kumar
- Department of Cardiology, Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Samhita Sengupta
- Department of Cardiology, Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Abeeha Naqvi
- Department of Cardiology, Creighton University School of Medicine, Phoenix, Arizona, USA
| | - Hursh Naik
- Department of Cardiology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
| |
Collapse
|
|
3
|
Espinoza J, Byer M, Vasquez M, Yavagal DR, Chatzizisis YS. Percutaneous coil embolization of a post-traumatic left anterior descending coronary artery pseudoaneurysm: a case report. Eur Heart J Case Rep 2024; 8:ytae625. [PMID: 39669553 PMCID: PMC11635634 DOI: 10.1093/ehjcr/ytae625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/27/2024] [Accepted: 11/18/2024] [Indexed: 12/14/2024]
Abstract
Background Coronary artery pseudoaneurysm (PSA) is a rare occurrence linked to percutaneous coronary interventions (PCIs), infection, or chest trauma, lacking established management guidelines due to its low incidence. Case summary A 78-year-old male with a medical history of triple vessel disease, post coronary artery bypass grafting, heart failure, and chronic obstructive pulmonary disease, presented with intractable left-sided chest pain following a mechanical fall. The initial workup was positive for mildly elevated high-sensitivity troponin and brain natriuretic peptide raising suspicion for a pulmonary embolism; but chest computed tomography angiography revealed an enlarging pericardial haematoma. Further computed tomographic coronary angiography exposed a mid-left anterior descending (LAD) interrupted segment concerning for a contained ruptured PSA. Left heart catheterization confirmed the suspicion, showing a collection of contrast at the haematoma site following injection of contrast into the saphenous vein graft to the diagonal artery. The patient underwent percutaneous PSA coiling, successfully occluding blood inflows from both the first diagonal and distal LAD. There were no subsequent electrocardiogram changes or further elevation in troponin levels ensuring the integrity of the LAD vital branches. Discussion Coronary PSA results from the dissection of at least one layer of the vessel wall leading to blood extravasation. Although they are usually associated with PCI complications, the absence of haemopericardium in prior imaging makes the recent blunt chest trauma the most likely cause of this patient's presentation. Percutaneous coiling of inflow vessels to PSAs proved to be a suitable option in this case of a patient with a history of sternotomy and an expanding pericardial haematoma.
Collapse
Affiliation(s)
- Joaquin Espinoza
- Division of Internal Medicine, University of Miami, Leonard M. Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Marina Byer
- Division of Cardiovascular Medicine, University of Miami, Leonard M. Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Moises Vasquez
- Division of Internal Medicine, University of Miami, Leonard M. Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Dileep R Yavagal
- Division of Neurosurgery and Endovascular Neurosurgery, University of Miami, Leonard M. Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Yiannis S Chatzizisis
- Division of Cardiovascular Medicine, University of Miami, Leonard M. Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| |
Collapse
|
|
4
|
Ma H, Qian H, Meng W. Case Report: Surgical management of traumatic giant coronary artery pseudoaneurysm with pericardial patch repair and ostium isolation. Front Cardiovasc Med 2024; 11:1462557. [PMID: 39582521 PMCID: PMC11582036 DOI: 10.3389/fcvm.2024.1462557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 10/16/2024] [Indexed: 11/26/2024] Open
Abstract
There is limited literature regarding cases of giant coronary artery aneurysms (GCAAs), and instances of giant coronary artery pseudoaneurysms caused by trauma are exceedingly rare. Here is a case presentation of an adult male who developed a giant coronary artery pseudoaneurysm following trauma. Successful surgical intervention was performed, involving repair of the aneurysmal opening with a pericardial patch and isolation of the right coronary artery ostium into the aortic root. One month postoperatively, a follow-up transthoracic echocardiogram revealed thrombotic occlusion within the residual lumen of the right coronary artery aneurysm, with contiguous echogenicity extending from the aortic sinus to the right coronary artery.
Collapse
Affiliation(s)
| | | | - Wei Meng
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
|
5
|
Gohbara M, Sugano T, Hibi K. Percutaneous coronary intervention for iatrogenic coronary artery pseudoaneurysm at left main trunk bifurcation: A case report. J Cardiol Cases 2024; 30:71-74. [PMID: 39483414 PMCID: PMC11523194 DOI: 10.1016/j.jccase.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 11/03/2024] Open
Abstract
A 70-year-old man was referred to our hospital with a diagnosis of progressive increase in extravasation leading to an iatrogenic coronary artery (CA) pseudoaneurysm within a month of percutaneous coronary intervention (PCI). The pseudoaneurysm was located on the carina side of the proximal left descending artery (LAD) accompanied by peri-stent contrast staining around the left main trunk (LMT). After a shared decision-making process, a second PCI was performed to prevent CA pseudoaneurysm rupture owing to concerns of adhesion around the LMT and difficulty in approaching the carina side of the proximal LAD for surgery. Coil embolization with four coils was performed and kissing stents with two covered stents were implanted. After the "Double-D molding technique," intravascular ultrasound imaging revealed only small residual spaces out of the stents. Final coronary angiography (CAG) revealed no contrast staining of the pseudoaneurysm. Four months after the PCI, follow-up CAG revealed no further pseudoaneurysm enlargement. To the best of our knowledge, this is the first case of PCI for a CA pseudoaneurysm at the LMT bifurcation treated using kissing stents with two covered stents. Learning objective Coil embolization and implantation of kissing stents with two covered stents with the "Double-D molding technique" is an optional method to stop further enlargement of the pseudoaneurysm at the left main trunk bifurcation.
Collapse
Affiliation(s)
- Masaomi Gohbara
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Teruyasu Sugano
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
|
6
|
Albriek AZ, Alamri S, Hamad F, Alshamiri M. Coronary artery intramural hematoma causing myocardial infarction mimicking pseudoaneurysm or dissection from trauma: A case report. Clin Case Rep 2024; 12:e8988. [PMID: 38939554 PMCID: PMC11208282 DOI: 10.1002/ccr3.8988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 06/29/2024] Open
Abstract
Blunt chest trauma caused ST-segment elevation myocardial infarction. Diagnosis of intramural hematoma (IMH) using computed tomography was confirmed using electrocardiography, cardiac marker tests, and subsequent coronary angiography. After conservative treatment, the hematoma was completely resolved 1 year later. Differentiating IMH from other arterial injuries is critical for appropriate management.
Collapse
Affiliation(s)
- Abdulilah Z. Albriek
- Department of Medical Imaging, Cardiothoracic Imaging SectionKing Saud Medical CityRiyadhSaudi Arabia
| | - Saad Alamri
- Cardiothoracic Imaging sectionSecurity Force HospitalRiyadhSaudi Arabia
| | - Faisal Hamad
- Department of Medical Imaging, Cardiothoracic Imaging SectionKing Saud Medical CityRiyadhSaudi Arabia
| | - Mostafa Alshamiri
- Department of Cardiac SciencesCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
| |
Collapse
|
|
7
|
Furui M, Matsumura H, Hayashida Y, Kuwahara G, Shimizu M, Morita Y, Matsuoka Y, Ito C, Hayama M, Wakamatsu K, Wada H. Repair of a right coronary artery rupture with perforated right ventricle following spontaneous pseudoaneurysm: a case report. Surg Case Rep 2024; 10:142. [PMID: 38864981 PMCID: PMC11169172 DOI: 10.1186/s40792-024-01941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Following the rupture of a coronary artery, a patient's condition usually deteriorates rapidly due to cardiac tamponade. A pseudoaneurysm due to a coronary artery rupture is rare; however, when a spontaneous coronary artery pseudoaneurysm occurs without tamponade, it creates a fistula in the right ventricle, often requiring surgical repair. CASE PRESENTATION This report describes the case of a 68-year-old man who presented with chest discomfort after a 12-day course of antibiotic treatment for bacteremia. Following coronary angiography, echocardiography, and enhanced computed tomography, he was diagnosed with a right coronary artery pseudoaneurysm accompanied with perforation of the right ventricle. Severe adhesions were observed during emergency surgery surrounding the entire heart. The patient presented with risk factors for coronary artery disease, including hypertension and smoking history. His coronary artery was severely calcified due to end-stage renal failure requiring dialysis; thus, a covered stent could not fit inside the arterial lumen. Consequently, coronary artery bypass grafting to the right coronary artery and right ventricle repair were performed. Unfortunately, the patient died postoperatively due to sepsis from intestinal translocation. This rare development was hypothesized to be an incidental result of the combination of severe post-inflammatory adhesions, extensive coronary artery calcification, and rupture of the calcification crevices. CONCLUSIONS In the case of a severe post-inflammatory response, shock without cardiac tamponade may require further scrutiny by assuming the possibility of inward rupture. For patients in poor condition, two-stage surgical treatment might be considered after stabilization with a covered stent.
Collapse
Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan.
| | - Hitoshi Matsumura
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Yoshio Hayashida
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Go Kuwahara
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Masayuki Shimizu
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Yuichi Morita
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Yuta Matsuoka
- Emergency Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Chihaya Ito
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Masato Hayama
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Kayo Wakamatsu
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| | - Hideichi Wada
- Cardiovascular Surgery Department, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-city, Fukuoka, 814-0180, Japan
| |
Collapse
|
|
8
|
Ruan YD, Han JW. Spontaneous coronary artery rupture after lung cancer surgery: A case report and review of literature. World J Cardiol 2024; 16:92-97. [PMID: 38456070 PMCID: PMC10915888 DOI: 10.4330/wjc.v16.i2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Spontaneous coronary artery rupture (SCAR) is a rare and life-threatening complication after lung cancer surgery. We present a case of SCAR following left upper lobectomy, successfully managed through emergency thoracotomy and coronary artery ligation. CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer. The surgery was performed using single-port video-assisted thoracoscopic surgery, and there were no observed complications during the procedure. However, 19 h after surgery, the patient experienced chest discomfort and subsequently developed severe symptoms, including nausea, vomiting, and a drop in blood pressure. Urgent measures were taken, leading to the diagnosis of SCAR. The patient underwent emergency thoracotomy and coronary artery ligation, successfully stopping the bleeding and stabilizing the condition. Despite postoperative complications, the patient made a successful recovery and was discharged from the hospital. CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery. Immediate thoracotomy has been shown to be a life-saving measure, while stenting is not the preferred initial approach.
Collapse
Affiliation(s)
- Ying-Ding Ruan
- Department of Thoracic Surgery, The First People's Hospital of Jiande, Jiande 311600, Zhejiang Province, China
| | - Jian-Wei Han
- Department of Thoracic Surgery, The First People's Hospital of Jiande, Jiande 311600, Zhejiang Province, China.
| |
Collapse
|
|
9
|
Inomata JI, Nakashima M, Kyono H. Coronary Artery Pseudoaneurysm 13 Years after Stent Implantation. Intern Med 2023; 62:2437-2439. [PMID: 37587060 PMCID: PMC10484769 DOI: 10.2169/internalmedicine.0894-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/06/2022] [Indexed: 08/18/2023] Open
|
|
10
|
Degtyar A, Baker TC, Punja M. No Ordinary Coronary: A Case Series of Two Large Coronary Artery Aneuryms Found on Chest X-Ray. J Emerg Med 2023; 64:47-50. [PMID: 36283902 DOI: 10.1016/j.jemermed.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/15/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Post-procedural coronary aneurysms can have high morbidity and mortality. Although found more commonly on ultrasound or computed tomography imaging, if large enough, they may appear on chest x-ray studies. CASE REPORTS We present two cases of coronary artery aneurysm visible on chest x-ray study-one originating from a saphenous vein graft and the other a left anterior descending artery pseudoaneurysm 1 week post heart catheterization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is important for emergency physicians to recognize abnormal chest x-ray studies and to look for post-procedural complications, such as coronary artery aneurysm. Coronary artery aneurysm can be a potentially life-threatening condition requiring prompt recognition and surgical consultation.
Collapse
Affiliation(s)
- Aleksandra Degtyar
- Emergency Department, Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - Thomas Cole Baker
- Emergency Department, Wellstar Kennestone Regional Medical Center, Marietta, GA
| | - Mohan Punja
- Emergency Department, Wellstar Kennestone Regional Medical Center, Marietta, GA
| |
Collapse
|
|
11
|
du Fretay XH, Aubry P. [Imaging of coronary aneurysms in adults' coronary aneurysms]. Ann Cardiol Angeiol (Paris) 2022; 71:391-398. [PMID: 36241480 DOI: 10.1016/j.ancard.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Coronary aneurysms are rare and of various etiologies in adults. Natural history, modalities of management and clinical monitoring remain poorly known due to the lack of large studies and homogeneous diagnostic and follow-up criteria in the published data. Coronary angiography is, so far, the most common diagnostic tool but can overlook some partially thrombosed aneurysmal. Intracoronary imaging, particularly intravascular ultrasound, can differentiate aneurysms from pseudoaneurysms considered by some to be at greater risk of events, requiring a curative treatment. Intracoronary imaging can also help with etiological assessment and percutaneous treatment. With its growing use in the search for coronary atheromatous disease, coronary CT angiography has become a major diagnostic tool for coronary aneurysms. In addition, that it can incidentally detect coronary aneurysms, coronary CT angiography is particularly useful for giant aneurysms poorly visualized on coronary angiography or less well evaluated by intracoronary imaging. It specifies their relationship with adjacent anatomical structures. It is also a non-invasive modality of monitoring. These three imaging tools are currently the most relevant in current practice pending large studies evaluating the natural history of coronary aneurysms, with the identification of possible risk factors that could modify the management.
Collapse
Affiliation(s)
- Xavier Halna du Fretay
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Cardioreliance, 45770, Saran, France.
| | - Pierre Aubry
- Département de Cardiologie, Hôpital Bichat Claude-Bernard, 75018, Paris, France; Service de Cardiologie, Centre Hospitalier de Gonesse, 95500, Gonesse, France
| |
Collapse
|
|
12
|
Sayed AI. Case report: Spontaneous coronary artery rupture presenting with acute coronary syndrome: A rare diagnosis of common disease. Front Cardiovasc Med 2022; 9:922180. [PMID: 36035904 PMCID: PMC9403242 DOI: 10.3389/fcvm.2022.922180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Acute coronary syndrome (ACS), myocardial infarction, and sudden death have all been linked to spontaneous coronary artery rapture (SCAR). Patients primarily afflicted by SCAR are those with or without cardiovascular risk factors, notably men, implying a mechanism distinct from the more prevalent atherosclerosis. Both medical and interventional treatment should consider the diverse causes of ACS as well as the patient's clinical stability. I herein report an unusual case of a 33 years old male who presented with acute chest pain to the emergency department. His physical exam was normal. The electrocardiogram showed non-specific ST segment changes in anterior leads, and the echocardiogram revealed mild anterior wall hypokinesia with no evidence of pericardial effusion. He underwent coronary angiography which revealed a contained rupture in the anterior descending coronary artery. The patient underwent uneventful lifesaving coronary artery perforation repair. It concluded that, though rare, SCAR should be considered as a differential diagnosis in patients with ACS, even in the absence of pericardial effusion in adult patients of all ages.
Collapse
|
|
13
|
Kim J, Cho JR, Kang MK. Spontaneus (dumbbell-shaped) coronary artery pseudoaneurysm after COVID-19 vaccination. Coron Artery Dis 2022; 33:429-430. [PMID: 35880562 PMCID: PMC9239353 DOI: 10.1097/mca.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Jung Rae Cho
- Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| | - Min-Kyung Kang
- Cardiology, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea
| |
Collapse
|
|
14
|
Ku L, Lv H, Yu Z, Ma X. Spontaneous regression of posttraumatic left anterior descending coronary pseudoaneurysm. J Card Surg 2022; 37:3393-3395. [PMID: 35830723 DOI: 10.1111/jocs.16770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Leizhi Ku
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hang Lv
- Department of Cardiac Function, Wuhan Asia General Hospital, Wuhan, China
| | - Zhengchun Yu
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
| | - Xiaojing Ma
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
| |
Collapse
|
|
15
|
Sharma R, Ruia AV. A case report of pseudoaneurysm of coronary artery within a month of percutaneous coronary intervention. Eur Heart J Case Rep 2022; 6:ytac175. [PMID: 35528126 PMCID: PMC9071343 DOI: 10.1093/ehjcr/ytac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/27/2021] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
Background Coronary artery pseudoaneurysms (PSAs) are uncommon and have poorly understood natural history. Unlike true aneurysms, PSAs do not have all the three layers of the vessel in the aneurysmal wall. The PSAs are most commonly seen after an overzealous percutaneous coronary intervention (PCI) which causes damage to the vessel wall. They usually develop slowly after PCI and PSAs within a month of a PCI are not so common. The PSA may be asymptomatic or present with recurrent angina. Case summary Here, we report a case of symptomatic PSA to right coronary artery (RCA). The patient had a myocardial infarction for which a PCI was performed to deploy a drug-eluting stent (DES) in the RCA. The patient had in-stent restenosis (ISR) within a week of PCI for which plain old balloon angioplasty (POBA) was performed. The patient continued to have unstable angina and within a month of POBA was diagnosed as a case of PSA by intravascular ultrasound. A covered stent was deployed which effectively sealed off the PSA and resumed normal blood flow to distal vessel. Patient has been doing well on medication [aspirin 75 mg once daily, atorvastatin 80 mg once daily, and P2Y12 platelet inhibitor (Ticagrelor) 90 mg twice daily]. Discussion The PSAs usually take 6-9 months to develop. However, PSAs have been reported within 1-2 months of PCI. This case also shows that PSAs can occur within a month of PCI. It is possible that over-aggressive and/or high-pressure dilatation and/or deep engagement during POBA performed to open up the ISR could have damaged the struts of the DES and compressed it against the vascular wall. The resultant vascular wall injury could have been the cause of early PSA formation in this case. Hence, cardiologists should be vigilant enough to suspect PSA, especially in a patient presenting with angina. The case also shows that covered stents are a viable option to treat early presentations of PSA.
Collapse
Affiliation(s)
- Raghav Sharma
- Department of Cardiology, Meditrina Hospital, Ambala 133001, Haryana, India
| | - Aditya Vikram Ruia
- Department of Cardiology, Meditrina Hospital, Ambala 133001, Haryana, India
| |
Collapse
|
|
16
|
Esposito L, Di Maio M, Silverio A, Cancro FP, Bellino M, Attisano T, Tarantino FF, Esposito G, Vecchione C, Galasso G, Baldi C. Treatment and Outcome of Patients With Coronary Artery Ectasia: Current Evidence and Novel Opportunities for an Old Dilemma. Front Cardiovasc Med 2022; 8:805727. [PMID: 35187112 PMCID: PMC8854288 DOI: 10.3389/fcvm.2021.805727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1. 5 times the normal adjacent segment. The term ectasia refers to a diffuse dilation, involving more than 50% of the length of the vessel, while the term aneurysm defines a focal vessel dilation. CAE is a relatively uncommon angiographic finding and its prevalence ranges between 0.3 and 5% of patients undergoing coronary angiography. Although its pathophysiology is still unclear, atherosclerosis seems to be the underlying mechanism in most cases. The prognostic role of CAE is also controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention. Despite the availability of different options for the interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, there is no one standard approach, as therapy is tailored to the individual patient. The abnormal coronary dilation, often associated with high thrombus burden in the setting of acute coronary syndromes, makes the interventional treatment of CAE patients challenging and often complicated by distal thrombus embolization and stent malapposition. Moreover, the optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them. In this review we aimed to provide an overview of the pathophysiology, classification, clinical presentation, natural history, and management of patients with CAE, with a focus on the challenges for both clinical and interventional cardiologists in daily clinical practice.
Collapse
Affiliation(s)
- Luca Esposito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- *Correspondence: Luca Esposito
| | - Marco Di Maio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | | | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Tiziana Attisano
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Vascular Pathophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Cesare Baldi
- Division of Interventional Cardiology, Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi, Salerno, Italy
| |
Collapse
|
|
17
|
Ruggerini S, Pavasini R, Quagliara TAP, Fiorani V. Case report: asymptomatic pseudoaneurysm of the native coronary soon after the graft anastomosis treated with off-pump repair. Eur Heart J Case Rep 2022; 6:ytac014. [PMID: 35295729 PMCID: PMC8922691 DOI: 10.1093/ehjcr/ytac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Background Pseudoaneurysms (PSAs) of native coronary arteries are rare but potentially lethal complications occurring after coronary artery graft anastomosis mainly secondary to median sternotomy. Case summary A 61-year-old man underwent coronary artery bypass grafting because of stable angina. After the surgery, the patient was asymptomatic. A routine pre-discharge transthoracic echocardiogram was performed showing a haematoma of the apex partially involving the right ventricle with systolic colour Doppler flow going from the left ventricle to the pericardium. A coronary computed tomography scan was ordered and it revealed the presence of a PSA of the left anterior descending (LAD) artery distal to the graft anastomosis with the left internal mammary artery. An off-pump direct suture of the LAD injury through a redo sternotomy was successfully performed. Discussion The development of a PSA of a native coronary artery after bypass grafting is a very rare and potentially fatal condition. A correct and prompt diagnosis is crucial to avoid lethal complication.
Collapse
Affiliation(s)
- Sara Ruggerini
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Teresa A P Quagliara
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| | - Vinicio Fiorani
- Cardiac Surgery Unit, Salus Hospital, Via Ulderico Levi 7, 42121 Reggio Emilia, Italy
| |
Collapse
|
|
18
|
Liang W, Yue H, Zhang T, Wu Z. Case Report: Hematoma Formation After Spontaneous Coronary Artery Rupture. Front Cardiovasc Med 2022; 8:801005. [PMID: 35087884 PMCID: PMC8787829 DOI: 10.3389/fcvm.2021.801005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023] Open
Abstract
We report a case of hematoma formation in the right coronary artery after spontaneous rupture. A 48-year-old female patient was admitted with a suspected right cardiac mass. Despite diagnostic work-up, the dignity of the mass could not be determined. Due to acute clinical symptoms, explorative surgery was decided and performed. Hereby, the mass was partially incised, and thrombus-like tissue was detected without active bleeding. We described the challenges during the diagnostic process, and the diagnosis was finally made according to a multimodality approach. For further assessment, we reviewed related literature and highlighted the importance of coronary angiography in the preoperative evaluation of such patients. The therapy may vary according to the location and size of such lesions.
Collapse
Affiliation(s)
- Weitao Liang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Honghua Yue
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tailong Zhang
- Union Hospital Affiliated With Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
|
19
|
Ye Z, Dong XF, Yan YM, Luo YK. Coronary artery aneurysm combined with myocardial bridge: A case report. World J Clin Cases 2021; 9:3996-4000. [PMID: 34141758 PMCID: PMC8180216 DOI: 10.12998/wjcc.v9.i16.3996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronary artery aneurysm combined with myocardial bridge is a very rare clinical situation. The prognosis of this clinical situation is not yet clear.
CASE SUMMARY A coronary artery aneurysm and myocardial bridge in the same segment of the coronary artery were found in a 54-year-old female patient who underwent coronary angiography and intravascular ultrasound examination. Through conservative treatment, the patient was discharged from the hospital smoothly, and she was in good condition during 5 mo of follow-up.
CONCLUSION Coronary artery aneurysm combined with myocardial bridge seems to have a good prognosis, but due to the rarity of this clinical situation, further research and follow-up are needed.
Collapse
Affiliation(s)
- Zhen Ye
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Institute of Coronary Artery Disease, Fuzhou 350001, Fujian Province, China
- Fujian Heart Medical Center, Fuzhou 350001, Fujian Province, China
| | - Xian-Feng Dong
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Institute of Coronary Artery Disease, Fuzhou 350001, Fujian Province, China
- Fujian Heart Medical Center, Fuzhou 350001, Fujian Province, China
| | - Yuan-Ming Yan
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Institute of Coronary Artery Disease, Fuzhou 350001, Fujian Province, China
- Fujian Heart Medical Center, Fuzhou 350001, Fujian Province, China
| | - Yu-Kun Luo
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
- Fujian Institute of Coronary Artery Disease, Fuzhou 350001, Fujian Province, China
- Fujian Heart Medical Center, Fuzhou 350001, Fujian Province, China
| |
Collapse
|
|
20
|
Nakagawa T, Hara H, Wakiya M, Hiroi Y. Coil embolization for ruptured coronary pseudoaneurysm causing haemopericardium: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab129. [PMID: 34124560 PMCID: PMC8189297 DOI: 10.1093/ehjcr/ytab129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/02/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022]
Abstract
Background Coronary artery pseudoaneurysm is a rare disease that can rupture and cause haemopericardium. It can occur principally as a complication after coronary artery instrumentation, but it can also result from trauma. Case summary A 15-year-old male patient with a history of spontaneous pneumothoraces treated twice with video-assisted thoracoscopic thoracic surgery presented with pericarditis and increasing haemopericardium. During the hospitalization, he had developed cardiogenic shock and he underwent emergent pericardiocentesis. Coronary angiography revealed a small right coronary artery pseudoaneurysm. We successfully coil embolized the pseudoaneurysm. Discussion This is a rare case of a ruptured coronary artery pseudoaneurysm associated with prior tube thoracostomy. The treatments for a coronary pseudoaneurysm should be tailored based on the pathologic and anatomical characteristics.
Collapse
Affiliation(s)
- Takashi Nakagawa
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Momoko Wakiya
- Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
| |
Collapse
|
|
21
|
Golouh V, Kobilica N, Breznik S. Superficial Femoral Artery Pseudoaneurysm and Arterial Wall Destruction After Drug-Coated Balloon Treatment. Cureus 2020; 12:e10527. [PMID: 33094068 PMCID: PMC7574979 DOI: 10.7759/cureus.10527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/17/2020] [Indexed: 12/24/2022] Open
Abstract
Drug-coated balloon angioplasty may present an efficient alternative to traditional balloon angioplasty and stenting, which suffer from high rates of restenosis and increased risk of stent fractures in the anatomically unfavorable regions, such as the superficial femoral artery in the adductor canal. Although pseudoaneurysms are the most common vascular access site complications, they are considerably rarer at the site of the endovascular treatment. They can be caused by several mechanisms, including stent fractures, usage of oversized balloons, high-pressure inflations, and infections. In addition, paclitaxel, the drug released from drug-coated balloons, may also play a significant role in the formation and exacerbation of pseudoaneurysms. The exact pathophysiology remains unclear, but it may be due to a combination of paclitaxel's suppression of neointimal healing and immune response, cytotoxic properties, and hypersensitivity-related inflammation.
Collapse
Affiliation(s)
- Valentin Golouh
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
| | - Nina Kobilica
- Department of Vascular Surgery, University Medical Centre Maribor, Maribor, SVN
| | - Silva Breznik
- Department of Radiology, University Medical Centre Maribor, Maribor, SVN
| |
Collapse
|
|
22
|
Cai Q, Gilani S. A leaking spontaneous coronary artery pseudoaneurysm. Proc (Bayl Univ Med Cent) 2020; 33:453-454. [DOI: 10.1080/08998280.2020.1759337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Qiangjun Cai
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| | - Syed Gilani
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas
| |
Collapse
|
|
23
|
Boukhris M, Hillani A, Adjibodou B, Mansour S. The Scary Bubbles: Management of an Unusual Complication of Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:e169-e171. [PMID: 31575515 DOI: 10.1016/j.jcin.2019.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Marouane Boukhris
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Montréal, Canada
| | - Ali Hillani
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Montréal, Canada
| | - Boris Adjibodou
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Montréal, Canada
| | - Samer Mansour
- Division of Cardiology, Centre Hospitalier de l'Université de Montréal (CHUM), Québec, Montréal, Canada.
| |
Collapse
|
|
24
|
Buono A, Maloberti A, Bossi IM, Piccaluga E, Piccalò G, Oreglia JA, Moreo A, Russo CF, Oliva F, Giannattasio C. Mycotic coronary aneurysms. J Cardiovasc Med (Hagerstown) 2019; 20:10-15. [DOI: 10.2459/jcm.0000000000000734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
|
25
|
Abstract
Saphenous vein graft (SVG) pseudoaneurysm is a rare complication of coronary artery bypass graft (CABG) surgery. Despite the high mortality associated with SVG pseudoaneurysm, there is no consensus on the optimal management of these pseudoaneurysms as they are infrequently reported in the literature. We report a case of a 55-year-old man with prior CABG surgery who presented with cough associated with hemoptysis and chest pain, and was found to have SVG pseudoaneurysm. The pseudoaneurysm was successfully closed with polytetrafluoroethylene (PTFE)-covered Jostent GraftMaster® (Abbott Vascular, Santa Clara, CA). We propose that GraftMaster is an effective means of treating SVG pseudoaneurysms percutaneously.
Collapse
Affiliation(s)
- Qasim Jehangir
- Cardiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Charles Lambert
- Cardiology, Florida Hospital Tampa Pepin Heart Institute, Tampa, USA
| | - Asad Sawar
- Cardiology, Florida Hospital Tampa Pepin Heart Institute, Tampa, USA
| |
Collapse
|
|
26
|
Hayashi T, Tanaka Y, Shishido K, Yokota S, Moriyama N, Tobita K, Yamanaka F, Mizuno S, Takahashi S, Saito S. Wire Bias, Insufficient Differential Sanding, and Orbital Atherectomy-Induced Coronary Pseudoaneurysm. Circ Cardiovasc Interv 2018; 11:e007003. [PMID: 30354637 DOI: 10.1161/circinterventions.118.007003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takahiro Hayashi
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Shohei Yokota
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Futoshi Yamanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Shingo Mizuno
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Saeko Takahashi
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital, Japan
| |
Collapse
|