E-Science Station

CASE20200923_004
Complications - Complications
Huge Coronary Aneurysm in Case of DES as a Very Late Complication! Our Experience
Manotosh Panja1
Belle vue Clinic, India1,
[Clinical Information]
- Patient initials or identifier number:
AA
-Relevant clinical history and physical exam:
58 Years,Diabetic,Non Hypertensive,Ex-Smoker.Anterior Wall AMI in last week of August 2004.Thrombolysed and conservatively managed.Discharged after 10 days with antiplatelets ,nitrates,ACEI and beta blockers.Started to have exertional chest pain after 3 weeks of discharge. 
-Relevant test results prior to catheterization:
TROP T Positive, Abnormal ECG-Evidence of Anterior Wall AMI, Pre Procedural hsCRP : 10mg/L, Post procedure hs-CRP: 12mg/L .Advised to undergo Coronary Angiography
- Relevant catheterization findings:
Coronary Angiography,done in early November.ProximalLAD-90% along with thrombus
[Interventional Management]
- Procedural step:
Diabetic status-Drug eluting stent-cypher.Floppywire,Stormer Ballon 2.5´15mminflated at 10 atmosphere .Cypher 3´18mmdeployed at 14atmosphere.Post procedure TIMI Grade III flow.Received LMWH(5days) with standard antiplatelets therapy : aspirin 75mg and clopidogrel 75mgalong atorvastatin 40mg,ACEI,nitrates and beta blockers& antidiabeticmedications.Discharged after 7 days of hospital stay without any complicationswith the above medicines. Pre Procedural hsCRP : 10mg/L, Post procedure hs-CRP:12mg/LAfter 14 months patient developed low grade fever andabdominal pain, resolved in 2-3 days.Subsequently developed chest pain..CHESTPAIN was constant,dull aching and had a dragging character occasionally painhad anginal character relieved with sublingual nitrates.Mostly not relievedwith any medication.Decision for repeat Coronary Angiography; done in middle ofDecember 2005.Patients Glycemic and Renal status normal all along
- Case Summary:
Huge coronary aneurysm in case of DES due to  infection/inflammation because of to reuse ofguide wire and guide catheter.Supportive evidence patient presented with feverand high hsCRP.Finally patient managed with CABG.
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