Marked malapposition and aneurysm formation after sirolimus-eluting coronary stent implantation

A 52-year-old female presented with an acute coronary syndrome, anterior T wave inversions, and elevated cardiac markers. After cardiac catheterization, a critical mid-left anterior descending artery (LAD) stenosis involving the origin of the second diagonal branch and a critical mid-right stenosis were observed. It was felt that the “culprit” vessel was the LAD, and a successful angioplasty was performed with a drug-eluting stent (DES), Cypher (Cordis), placed in the LAD and the diagonal branch dilated with a balloon. The right coronary artery (RCA) was treated with a drug-eluting stent 3 days later (Figure 1 …