Acute Left Main Coronary Occlusion Caused by Stent Fracture, Peri-Stent Aneurysm Formation, and Very-Late Stent Thrombosis: Revisiting the Dark Side of.

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Acute Left Main Coronary Occlusion Caused by Stent Fracture, Peri-Stent Aneurysm Formation, and Very-Late Stent Thrombosis: Revisiting the Dark Side of Drug-Eluting Stents Benoit Daneault, MD, Stacy Baird, MD, Ajay J. Kirtane, MD, SM Canadian Journal of Cardiology Volume 30, Issue 1, Pages 146.e1-146.e3 (January 2014) DOI: 10.1016/j.cjca.2013.07.677 Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions

Figure 1 After thromboaspiration in left anterior descending artery and LCX, TIMI flow 3 is restored in the left system. A coronary aneurysm (arrow) is seen in the LCX, at the site of the bifurcation with the first obtuse marginal (previously covered by sirolimus-eluting stent). LCX, left circumflex artery; TIMI, Thrombolysis in Myocardial Infarction. Canadian Journal of Cardiology 2014 30, 146.e1-146.e3DOI: (10.1016/j.cjca.2013.07.677) Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Intravascular ultrasound of the LCX-OM2. (A) OM2 distal to the bifurcation. One layer of stent is seen with good apposition and expansion and minimal neointima formation. (B) The mid part of the aneurysm with no visible stent strut, compatible with a type V fracture. (C) The proximal part of the aneurysm with some stent strut (arrow). (D) The vessel proximal to the aneurysm. Two layers of stent are visible (arrow). There is good expansion and apposition with minimal neointima formation. LCX, left circumflex artery; OM2, second obtuse marginal. Canadian Journal of Cardiology 2014 30, 146.e1-146.e3DOI: (10.1016/j.cjca.2013.07.677) Copyright © 2014 Canadian Cardiovascular Society Terms and Conditions