Double Total Occlusion of Bioresorbable Scaffold in a Young Patient with Coronary Artery Ectasia.

Coronary artery ectasia (CAE) is found in up to 1.2%-4.9% of patients undergoing coronary angiography, with predilection for men.1,2 Most affected artery is right coronary artery (RCA) (40%), followed by the left anterior descending (LAD) (32%) and the left main artery (LCx) (3.5%).3 Coronary artery aneurysm (CAA) was defined as dilated diameter of coronary artery of at least 1.5 times compared with normal adjacent segments or the largest coronary artery.4 CAE and CAA have previously been used interchangeably, however, the term CAE is used to define more diffuse aneurysmal lesions.4,5 CAA coexisted with coronary artery disease (CAD) more frequently than CAE, and the average maximum diameter was smaller in CAA. Multivariate analysis showed independent variables associated with CAA rather than CAE, including hyperlipidemia, smoking, and family history of CAD.5 Within aneurysmal segments, abnormal laminar flow and platelet-endothelial-derived pathophysiologic factors lead to thrombus formation.6 Clinical symptoms range from asymptomatic, effort angina to acute coronary syndrome.4 The majority of published studies assessed percutaneous coronary intervention (PCI) outcomes in patients with CAE was under clinical setting of acute myocardial infarction, whereas discussions of asymptomatic patients or elective intervention were only limited small case series.7 The treatment modality of elective intervention (covered stent exclusion, stent-assisted coil embolization, or surgical exclusion) differs according to the shape and extent of the lesion.4 Intracoronary manipulation of CAE has complications of distal embolization, no-reflow phenomenon, stent malapposition, dissection and rupture. Furthermore, iatrogenic CAE was also induced after stenting.4