血管炎ジャーナル

Double Stenting Technique for Successfully Closure of Coronary Aneurysm in Behçet’s Disease “Case Report of Coronary-Behçet”

Abstract

Nassime Zaoui*, Amina Boukabous, Tarik Mokrab, Nadhir Bachir, Nabil Irid and Ali Terki

Behçet’s disease is an immune-mediated vascularitis characterized by oral and genital ulcerations, manifestations affecting the skin, eyes, central nervous system and musculoskeletal system. Arterial involvement is less common than venous involvement. The coronary arteries are rarely affected, only about 20 cases with coronary aneurysm, with still unknown etiopathogenesis and treatment, have been described in the literature. Regarding the high rupture risk, percutaneous coronary intervention is rarely performed with delayed endothelialization due to inflammatory process requiring prolonged anticoagulation. We present the case of 33-years-old man with Behçet’s disease in remission presenting to our department with an acute coronary syndrome. Angiography revealed a large coronary aneurysm developed from the circumflex artery, followed by a 1-1-1 Medina lesion at its bifurcation with the first obtuse-marginal. We performed a double stents technique using CULOTTE-technique that helped stabilize the patient with a partial aneurysm thrombosis. Angiography at 5 days confirmed the complete aneurysm thrombosis. He was discharged under Aspirin 100mg, Clopidogrel 75 mg, Rivaroxaban 10mg for 1 month and Prednisone with a coronary CT scan at 3 months. The Culotte-technique enabled to gradually exclude the aneurysm by placing a double struts layer facing its neck. In the event of obstruction failure, the other alternatives are a covered stent placement (combined with DES) or coils deployment in the aneurysm through the stents struts and finally the surgical resection with an aorto-coronary bypass. Coronary-Behçet is rare; most cases are seen in young men. Our case demonstrates the necessity of regular coronary noninvasive check-up in Behçet patients.