False aneurysm of the wall of a venous graft in a patient with an implanted MGuard type of coronary stent: case report and description of the microscopic changes

Authors: Tomáš Jirásek 1;  Viktor Kočka 2;  Ondrej Szárszoi 3;  Jan Pirk 3
Authors‘ workplace: Ústav patologie 3. LF UK a FNKV, Praha 1;  III. interní-kardiologická klinika 3. LF UK a FNKV, Praha 2;  Klinika kardiovaskulární chirurgie IKEM, Praha 3
Published in: Čes.-slov. Patol., 49, 2013, No. 3, p. 137-140
Category: Reviews Article


The present case report demonstrates a development of a false aneurysm in a venous coronary bypass graft wall, which developed at the previous MGuard stent implantation area in a 67-year-old patient. Subsequent histological examination revealed a false aneurysm image, without detection of vascular wall layers in its wall. Microscopically mild neointimal proliferation within the stent was also detected, with a strong granulomatous inflammatory reaction, mostly focused on the PET fibre mesh present on the surface of the stent. This article demonstrates the need for a multidisciplinary approach in dealing with pathological changes in stented blood vessels; the authors would also like to remind the public of the possibility of histological examination of stented vessels in the Czech Republic.

coronary bypass – pseudoaneurysm – PCI – MGuard stent – histology


1. Riahi M, Vasu CM, Tomatis LA, Schlosser RJ, Zimmerman G. Aneurysm of saphenous vein bypass graft to coronary artery. J Thorac Cardiovasc Surg 1975; 70(2): 358–359.

2. Sherry CS, Harms SE. MR imaging of pseudoaneurysms in aortocoronary bypass graft. J Comput Assist Tomogr 1989; 13(3): 426–429.

3. Ennis BM, Zientek DM, Ruggie NT, Billhardt RA, Klein LW. Characterization of a saphenous vein graft aneurysm by intravascular ultrasound and computerized three-dimensional reconstruction. Cathet Cardiovasc Diagn 1993; 28(4): 328–331.

4. Dieter RS, Patel AK, Yandow D, et al. Conservative vs. invasive treatment of aortocoronary saphenous vein graft aneurysms: Treatment algorithm based upon a large series. Cardiovasc Surg 2003; 11(6): 507–513.

5. Brilakis ES, Lichtenwalter C, de Lemos JA, et al. A randomized controlled trial of a paclitaxel-eluting stent versus a similar bare-metal stent in saphenous vein graft lesions the SOS (Stenting of Saphenous Vein Grafts) trial. J Am Coll Cardiol 2009; 53(11): 919–928.

6. Mehilli J, Pache J, Abdel-Wahab M, et al. Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet 2011; 378(9796): 1071–1078.

7. Couto WJ, Livesay JJ, Allam A. Off-pump repair of a giant pseudoaneurysm of a distal saphenous vein bypass graft. Ann Thorac Surg 2005; 80(6): 2376–2378.

8. Gyenes G, Lazzam C, Feindel C, Roth SL. Successful treatment of a saphenous vein graft pseudoaneurysm with PTFE-covered JoStents. Can J Cardiol 2003; 19(5): 569–571.

9. Kavanagh EC, Hargaden G, Flanagan F, Murray JG. CT of a ruptured vein graft pseudoaneurysm: an unusual cause of superior vena cava obstruction. AJR Am J Roentgenol 2004; 183(5): 1239–1240.

10. Topaz O, Rutherford MS, Mackey-Bojack S, et al. Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates. Cardiovasc Pathol 2005; 14(6): 298–302.

11. Kaluski E, Groothuis A, Klapholz M, Seifart P, Edelman E. Coronary stenting with M-Guard: feasibility and safety porcine trial. J Invasive Cardiol 2007; 19(8): 326–330.

12. Robinson FC. Aneurysms of the coronary arteries. Am Heart J 1985; 109(1): 129–135.

13. Caruso M, Evola S, Fattouch K, et al. Chest pain duelante huge coronary pseudoaneurysm following stent implantation. Intern Med 2011; 50(6): 577–579.

14. Kitzis I, Kornowski R, Miller HI. Delayed development of a pseudoaneurysm in the left circumflex artery following angioplasty and stent placement, treated with intravascular ultrasound-guided stenting. Cathet Cardiovasc Diagn 1997; 42(1): 51–53.

15. Schobel WA, Voelker W, Haase KK, Karsch KR. Occurrence of a saccular pseudoaneurysm formation two weeks after perforation on the left anterior descending coronary artery during baloon angioplasty in acute myocardial infarction. Cathet Cardiovasc Interv 1999; 47(3): 341–346.

16. Okamura T, Hiro T, Fujii T, et al. Large giant coronary aneurysm associated with a fracture of sirolimus eluting stent: a case report. J Cardiol 2008; 51(1): 74–79.

17. Ruin-Nodar JM, Valencia J, Pineda J. Coronary aneurysm after drug-eluting stent implantation. Eur H Journal 2007; 28(23): 2826.

18. Zbinden R, Eshtehardi P, Cook S. Coronary aneurysm formation in a patient early after everolimus-eluting stent: a case report. J Invasive Cardiol 2008; 20(5): 174–175.

19. Kornowski R, Hong MK, Tio FO, Bramwell O, Wu H, Leon MB. Contribution of inflammatory responses and aterial injury to neointimal hyperplasia. JACC 1998; 31(1): 224–230.

20. Schwartz RS, Edelman ER, Carter A, et al. Drug-eluting stents in preclinical studies: Recommended evaluation from a consensus group. Circulation 2002; 106(14): 1867–1873.

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