Giant coronary aneurysm management with Viabahn covered stent

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• A 68-year-old female patient presented with a history of coronary artery bypass surgery (CABG) complicated by a giant coronary artery aneurysm (CAA) of the proximal right coronary artery.
• The patient had severe three-vessel disease, including significant stenosis in the right coronary artery and left anterior descending artery, and a total occlusion of the left circumflex artery.

Observation:

• Post-CABG imaging revealed significant enlargement of the CAA, with retrograde flow from a bypass graft and antegrade flow through a stenotic native vessel.
• Initial attempts at percutaneous covered stent insertion were challenging due to the aneurysm's size and the rigidity of the stent delivery system.

Findings:

• A novel technique employing a distal anchoring strategy and dual guide catheters was successfully used to deploy two Viabahn covered stents (5x50mm).
• This approach facilitated the challenging passage of stents through the complex anatomy of the giant coronary artery aneurysm.

Implications:

• This case demonstrates the feasibility and success of a specialized percutaneous technique for managing large and complex coronary artery aneurysms.
• The described dual-catheter method offers a potential solution for similar challenging cases, expanding interventional treatment options for coronary artery pathology.