Late Development Localized Aneurysmal Ectasia of Stented Coronary Segments after Sirolimus-Eluting Stent Placement, a Case Series

Abstract

This case series reviews 3 patients who presented with aneurysmal ectasia, suggestive of pseudoaneurysms, at the site of coronary Cypher drug-eluting stents (DES) with Sirolimus as the eluting agent. We examine risk factors and possible etiologies of DES and Sirolimus related aneurysmal formation, specifically focusing on inhibited vessel healing, increased vascular wall apoptosis, as well as inflammatory and hypersensitivity reactions. We also examine various treatment options, including stenting the lesion with a Jomed covered stent. The clinical value of this report is to foster awareness of aneurysms and pseudoaneurysms as possible complications at stented coronary arteries. The patients described include a 56 year-old male with a Left Anterior Descending (LAD) aneurysmal formation 2 years after a Cypher stent placement, 54 year-old male with multiple areas of LAD ectasia at both Cypher stent sites 1 year after placement, and a 47 year-old female with LAD ectasia at the Cypher stent site 10 months after the intervention.