Onur YILDIRIM, Yusuf ATMACA, Başar CANDEMİR, Menekşe GEREDE ULUDAĞ, Hüseyin GÖKSÜLÜK, Çetin EROL

Sistemik Lupus Eritematozus Olan Bir Hastada Dev Sakküler Koroner Anevrizmanin Greft Stent İle Perkütan Tedavisi*

Koroner arter anevrizması/ektazisi (KAE) koroner arter segmentinin normal damar çapının 1.5 katından fazla ge-nișlemesi olarak tanımlanır. En sık etyolojik nedeni aterosklerotik koroner arter hastalığıdır; fakat, romatizmal has-talıklarda (Kawasaki hastalığı, Takayasu arteriti, sistemik lupus eritematozus (SLE), Romatoid artrit gibi) inflamas-yona sekonder nadiren görülebilir. Biz burada daha önce koroner arter girișim hikayesi ve SLE tanısı olan bir has-tada, dev koroner arter anevrizmasını, olası etyolojik nedenini ve tedavisini sunmayı amaçladık. Tedavide, anev-rizma greft stent ile kapatıldı. Hastada, klinik bulgulara ve laboratuvar verilerine göre SLE remisyonda idi. Bu ne-denle, anevrizmanın daha önce takılan ilaç salınımlı stente sekonder geliștiği düșünüldü. Bu vaka sunumu ile, ko-roner arter hastalığı geleneksel risk faktörleri olmayan SLE hastalarında, koroner arter hastalığının düșünülmesi gerektiği vurgulanmıștır.

Percutaneous Treatment of a Giant Coronary Aneurysm Using a Greft Stent in a Patient with Systemic Lupus Erythematosus

Coronary artery aneurysm/ectasia (CAE) is defined as a dilatation of a coronary artery segment to more than 1.5-fold normal size in diameter. The leading etiologic factor of CAE is atherosclerotic coronary artery disease, but it can be seen rarely secondary to inflammatory diseases in romatological diseases (e.g. Kawasaki disease, Takayasu’s arteritis, Systemic Lupus Erythematosus (SLE), rheumatoid arthritis). We present here in a giant coronary aneurysm, possible etiologic causes and treatment in a patient with SLE who had a previous coronary intervention. Treatment was performed successfully with a covered stent. We thought that the aneurysm was developed secondary to the drug eluting stent that was previously implanted while SLE was in remission. This case report emphasizes that coronary artery disease should be considered in SLE patients who do not have traditional risk factors for coronary artery disease.

PDF

___

18. Wilson VE, Eck SL, Bates ER. Evaluation and treatment of acute myocardial infarction complicating systemic lupus erythematosus. Chest 1992; 101: 420-424.
17. Curcio A, Torella D, Cuda G. Effect of stent coating alone on in vitro vascular smooth muscle cell proliferation and apoptosis. Am J Physiol Heart Circ Physiol 2004; 286: H902–H908.
16. Van der Giessen WJ, Lincoff M, Schwartz RS. Marked inflammatory sequelae to implantation of biodegradable and nonbiodegradable polymers in porcine coronary arteries. Circulation 1996; 94: 1690–1697.
15. Heldman AW, Cheng L, Jenkins GM. Paclitaxel stent coating inhibits neointimal hyperplasia at 4 weeks in a porcine model of coronary restenosis. Circulation 2001; 103: 2289–2295.
14. Farb A, Heller PF, Shroff S. Pathological analysis of local delivery of paclitaxel via a polymer-coated stent. Circulation 2001; 104: 473–479.
13. Korbet SM, Schwartz MM, Lewis EJ. Immune complex deposition and coronary vasculitis in systemic lupus erythematosus. Am J Med 1984; 77: 141–146.
12. Villines TC, Avedissian LS, Elgin EE. Diffuse nonatherosclerotic coronary aneurysms. Cardiol Rev. 2005; 13: 309 – 311.
11. Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia: its prevalence and clinical significance in 4993 patients. Br Heart J. 1985; 54: 392–395.
Aqel RA, Zoghbi GJ, Iskandrian A: Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: A review. Echocardiography 2004;21:175–182
9. Robertson T, Fisher L: Prognostic significance of coronary artery aneurysm and ectasia in the coronary artery surgery study (CASS) registry, in Shulman ST (ed): Kawasaki disease: Proceedings of the Second International Kawasaki Symposium. New York, NY, A.R. Liss, 1987; 325-339.
8. Swaye PS, Fisher LD, Litwin P: Aneurysmal coronary artery disease. Circulation 1983; 67: 134-138
7. Suzuki H, Fujigaki Y, Mori M. Giant coro nary aneurysm in a patient with systemic lupus erythematosus. Intern Med. 2009;48: 1407-1412.
6. Korbet SM, Schwartz MM, Lewis EJ. Im-mune complex deposition and coronary vasculitis in systemic lupus erythematosus. Report of two cases. Am J Med. 1984;77:141-146.
5. Burkley BH, Roberts WC. The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy: a study of 36 necropsy patients. Am J Med 1975;58:242–264.
4. Petri M, Spence D, Bone LR et al. Coro-nary artery disease risk factors in the Johns Hopkins Lupus Cohort: Prevalence, re-cognition by patients, and preventive prac-tices. Medicine 1992; 71: 291-302.
3. Moder KG, Miller TD, Tazelaar HD. Car-diac involvement in systemic lupus erythe-matosus. Mayo Clin Proc 1999; 74: 275-284.
2. Nagao T, Ito K, Tsuboi H et al. Rare complications of systemic lupus erythema-tosus. Intern Med. 2012; 51: 3101-3102.
1. Syed M, Lesch M. Coronary artery aneurysm: a review. Prog Cardiovasc Dis 1997; 40: 77-84.