Intravascular findings post-PK Papyrus-covered stent implantation for a coronary artery aneurysm

概要

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Intravascular findings post-PK Papyrus-covered
stent implantation for a coronary artery
aneurysm

Yamamoto, Hiroyuki
Miyata, Taishi
Kawai, Hiroya
Takaya, Tomofumi
(Citation)
European Heart Journal : Case Reports,7(5):ytad215

(Issue Date)
2023-05

(Resource Type)
journal article

(Version)
Version of Record

(Rights)
© The Author(s) 2023. Published by Oxford University Press on behalf of the European
Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License, which permits non-commercial re-use, distribution…
and
reproduction in any medium, provided the original work is properly cited. For
(URL)
commercial re-use, please contact journals.permissions@oup.com
https://hdl.handle.net/20.500.14094/0100485974

European Heart Journal - Case Reports (2023) 7, 1–2
https://doi.org/10.1093/ehjcr/ytad215

IMAGES IN CARDIOLOGY
Coronary intervention

Hiroyuki Yamamoto
and Tomofumi Takaya

1†

, Taishi Miyata1, Hiroya Kawai1,2,
1,2 †
*

1

Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji 6708560, Japan; and
Department of Exploratory and Advanced Research in Cardiology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 6500017, Japan

2

Received 15 December 2022; first decision 3 March 2023; accepted 21 April 2023; online publish-ahead-of-print 24 April 2023

Figure 1 (A) Coronary angiography and (B) intravascular ultrasound after previous percutaneous coronary intervention with a drug-coated balloon
angioplasty. Coronary angiography; (C) an acute occlusion in the mid-left anterior descending artery, (D) after thromboaspiration and (F) PK
Papyrus-covered stent implantation. (E and G) Comparison of intravascular ultrasound and optimal frequency domain imaging findings; (E) after throm­
boaspiration and (G) PK Papyrus-covered stent implantation. Intravascular ultrasound visualizes the aneurysm (red arrowheads), but optimal frequency
domain imaging cannot visualize it (dotted arrowheads). However, optimal frequency domain imaging indicates thrombus (arrows) before stenting and
multiple intra-stent thrombi, which is newly developed after stent implantation (yellow arrowheads).

* Corresponding author: Tel: +81-79-289-5080, Fax: +81-79-289-2080, Email: toto54@hotmail.com
These authors share the lead authorship and contributed equally to the study.
Handling Editor: Francesco Moroni
Peer-reviewers: Andi Rroku; Aisha Gohar
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits
non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

†

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Intravascular findings post-PK Papyrus-covered
stent implantation for a coronary artery
aneurysm

2

Case description

Papyrus-covered stents are reportedly useful for coronary artery per­
foration and CAAs, despite higher cardiovascular event rates, including
stent thrombosis and restenosis, in selected cases.2 In cases requiring
PK Papyrus-covered stent implantation, IVUS and OFDI have varying
capabilities in evaluating outer (vessel)/inner (luminal) conditions, which
may help clarify the appropriate management for these patients.3
Consent: In line with the COPE guidelines, informed consent was ob­
tained from the patient for the participation in this study and publica­
tion of the case and accompanying images.
Conflict of interest: None declared.
Funding: None declared.

Data availability
The data included in this study are available in the article and its online
Supplementary material.

References
1. Kleber F, Schulz A, Bonaventura K, Fengler A. No indication for an unexpected high rate
of coronary artery aneurysms after angioplasty with drug-coated balloons.
EuroIntervention 2013;9:608–612.
2. Will M, Kwok CS, Nagaraja V, Potluri R, Weiss TW, Mascherbauer J, et al. Outcomes of
patients who undergo elective covered stent treatment for coronary artery aneurysms.
Cardiovasc Revasc Med 2022;36:91–96.
3. Kobayashi Y, Kitahara H, Tanaka S, Okada K, Kimura T, Ikeno F, et al. Quantitative pre­
cision of optical frequency domain imaging: direct comparison with frequency domain
optical coherence tomography and intravascular ultrasound. Cardiovasc Interv Ther
2016;31:79–88.

Downloaded from https://academic.oup.com/ehjcr/article/7/5/ytad215/7140389 by Kobe Daigaku user on 27 December 2023

A 50-year-old southeast Asian man with exertional angina pectoris
underwent elective percutaneous coronary intervention involving the
mid-left anterior descending (LAD) artery (small vessel disease
<3.0 mm) using a 2.5-/30-mm drug-coated balloon (DCB; SeQuent
Please, B. Braun Melsungen AG, Germany). Four months afterward
[3-month dual antiplatelet therapy (DAPT) with aspirin 100 mg/day
and prasugrel 3.75 mg/day, and subsequent single antiplatelet therapy
with aspirin 100 mg/day as per the Japanese guidelines], the patient ex­
perienced an anterior ST-segment elevation myocardial infarction
(STEMI) (Figure 1A and B). Emergency coronary angiography revealed
an acute occlusion of the mid-LAD artery, in which the DCB had
been used previously. Intravascular ultrasound (IVUS; AltaView,
Terumo Corp, Japan) and optical frequency domain imaging (OFDI;
FastView, Terumo Corp, Japan) after thromboaspiration revealed a
coronary artery aneurysm (CAA) (Figure 1C, D, and E). Drug-eluting
stent implantation for the CAA (maximum lumen diameter, 6.2 mm)
was considered unsuitable given the risk of acute stent occlusion due
to stent malapposition. Therefore, a 2.5-/20-mm covered stent (PK
Papyrus, BIOTRONIK, Inc., Germany) was implanted with nominal
pressure, resulting in complete coverage of the CAA, as visualized on
IVUS images. OFDI did not show the aneurysm (vessel condition) ex­
ternal to the covered stent, but clearly detected luminal conditions, in­
cluding multiple minor intra-stent thrombi that required additional
3.0-mm non-compliant balloon angioplasties (Figure 1F and G). The pa­
tient was discharged after 11 days without further complications and
had an uneventful clinical course for 4 months under the same
DAPT regimen.
DCB angioplasty potentially leads to CAA (DCB-related CAA); how­
ever, STEMI associated with DCB-related CAA is rare.1 PK

H. Yamamoto et al. ...

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