CONGRESS ABSTRACT

Rational: coronary artery aneurysms are reported between 0.1-4.9% in coronary angiographies. Vessel wall weakening, inflammation and endothelial damage play a role in their development. They may compromise the coronary flow and play a source for thrombus development, resulting in acute myocardial infarction. Aneurysmal lesions are the interventional cardiologist’s Achilles heel, given the failure of BMS, I° and II° generation DES and covered stents.  A 69 years-old man with previous stroke resulting in epilepsy come to our cath-lab with Inferior STEMI. Cardiovascular risk factors were familial history, hypertension and dyslipidemia. At angiography the right coronary shows from the proximal segment to distal segment a large aneurysmal dilatation filled with thrombus.  Repeated dilations and thromboaspirations resulted in a partial recanalization of the coronary artery, for which it was decided to practice infusion of GP IIb/IIIa repeating the coronary angiography after 24 hours. On angiographic control thrombotic material persisted within the aneurysmal coronary artery from mid to distal segment, for which it was decided to implant a RoadSaver to treat this lesion.       Technical resolution: the RoadSaver stent has micro-mesh made of nitinol placed inside the closed-cell design stent frame. The stent frame strut thickness is 180 μm, while the metal mesh strut size and pore size are 42 μm and 375 μm, respectively. RoadSaver design provides sustained embolic protection by extensive plaque coverage and prevention of plaque prolapse, effectively adapting to coronary anatomy. These features made it possible to easily implant this stent using a radial approach and JR 4.0 7F catheter on Whisper ES guidewire. Postdilatation was performed with NC balloon 6.0x20mm. After 83 days, coronary angiography with OCT study of this right coronary was performed showing optimal apposition of the dual-layer stent without restenosis.    Clinical implications: in the acute scenario, the dual-layer micromesh stent RoadSaver avoids the embolizations and plaque prolapse. This would prevent the use of downstream anticoagulants / thrombolytics due to ineffective results that can occur with DES and / or thromboaspirations.   Perspectives: the dual-layer micromesh stent RoadSaver is feasible and safe in treating  aneurysmatic coronary lesions, especially in acute scenarios. Efficacy needs to be further estabilished in larger randomized trials.