Early Aneurysm Formation After Everolimus-Eluting Stent Implantation
A 65-year-old woman with hypertension and dyslipidemia presented with rest chest pain in the setting of 2 mm ST depression in ECG leads V3-V6 and a troponin T level (TnT) of 0.92 ng/mL (normal, <0.08 ng/mL). Emergent cardiac catheterization, performed for the non-ST elevation myocardial infarction (NSTEMI), revealed a 60% proximal left anterior descending artery (LAD) bifurcation lesion involving an 80% lesion in the first diagonal branch (D1) and a 90% first obtuse marginal artery (OM1) lesion (Figure [A]). Fractional flow reserve (FFR) of the LAD was 0.78, and the LAD was successfully treated with a bifurcation approach using a 2.75×12 mm everolimus-eluting stent (EES, Xience Prime, Abbott Vascular, Redwood City, CA) in the LAD and a 2.25×20 mm EES (Promus Element, Boston Scientific, Natick, MA) in D1; both deployed at 10 atmospheres (atm). The OM1 was treated with a 2.25×12 mm EES (Xience Prime) deployed at 10 atm. Full details of coronary interventions are available in the Data Supplement. There was no angiographic evidence of dissection or incomplete expansion after stent placement. She was discharged on dual antiplatelet therapy.