Giant coronary aneurysm culprit of an acute coronary syndrome
Iván J Núñez-Gil1, Pedro Marcos Alberca1, Nieves Gonzalo1
1Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Insights
This study presents a complex case of myocardial infarction in a patient with multiple comorbidities. A multimodality approach successfully treated extensive coronary artery disease, including a giant aneurysm.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- A 66-year-old male with hypertension, type 2 diabetes mellitus, and dyslipidemia presented with non-ST segment elevation myocardial infarction.
- The patient was an ex-smoker, highlighting the impact of lifestyle factors on cardiovascular health.
Observation:
- Cardiac catheterization revealed extensive and calcified coronary artery disease.
- Specific findings included chronic total obstruction of the right coronary artery and a giant aneurysm in the first marginal branch, identified as the culprit lesion.
Findings:
- A successful multimodality treatment strategy was employed.
- The right coronary artery obstruction was addressed, followed by stent graft closure of the giant aneurysm.
- Two drug-eluting stents were used to treat multiple severe stenoses within the affected vessel.
Implications:
- This case highlights the successful management of complex coronary artery disease involving aneurysms and extensive calcification.
- The use of a stent graft and drug-eluting stents demonstrates effective therapeutic options for challenging vascular interventions.
- A comprehensive, multimodality approach is crucial for optimizing outcomes in patients with intricate cardiovascular conditions.
Abstract:
A 66-year-old male ex-smoker with hypertension, type 2 diabetes mellitus and dyslipidaemia was admitted due to a non-ST segment elevation myocardial infarction. The catheterisation depicted an extensive and calcified disease: chronic total obstruction of the right coronary and severe disease with a giant aneurysm at the first marginal branch as the culprit vessel. After discussion, the right coronary was treated before the circumflex-giant aneurysm was closed with a stent graft and its multiple severe stenosis solved with two drug-eluting stents. We provide a multimodality approach for a complex case and briefly discuss the available options.
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