Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation.
Atif HassanBarry F UretskyAndres M Vargas EstradaRomesa HassanMalek Al-HawwasShiv Kumar AgarwalPublished in: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (2020)
Pseudoaneurysm (PSA) formation is a rare but well-known complication of coronary stenting. It develops after a procedural perforation disrupts the integrity of the vessel wall but is contained by a single wall layer, usually pericardium, extravascular thrombosis and later fibrosis. Medical literature of PSA consists primarily of case reports. A systematic review of pseudoaneurysm after coronary stenting was performed to summarize its presentation, diagnostic imaging modalities, natural history, and management approaches. Clinical presentations range from asymptomatic to hemodynamic collapse, size from small to "giant," and treatment approaches from surgical or percutaneous exclusion to "watchful waiting" and imaging surveillance. Based on current information, a management algorithm is provided recommending urgent to emergent exclusion for symptomatic PSA, elective exclusion for large and giant PSA, and "watchful waiting" and periodic imaging surveillance for small to moderate sized PSA.
Keyphrases
- prostate cancer
- systematic review
- radical prostatectomy
- high resolution
- coronary artery disease
- coronary artery
- public health
- healthcare
- case report
- machine learning
- randomized controlled trial
- antiplatelet therapy
- meta analyses
- aortic stenosis
- high intensity
- acute coronary syndrome
- combination therapy
- transcatheter aortic valve replacement
- radiofrequency ablation
- replacement therapy
- clinical evaluation