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Multi-vessel giant coronary artery aneurysms: An unusual cause of chest pain

Melissa G Y Lee1,2, Jeffrey Lefkovits1,2,3, Subodh B Joshi1,2

  • 1Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.

Radiology Case Reports
|December 30, 2022
PubMed

Insights

This case study details a patient with giant coronary artery aneurysms who experienced acute coronary syndrome. Management involved dual antiplatelet therapy and later anticoagulation, highlighting the complexity of treating this rare condition.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Giant coronary artery aneurysms are rare vascular abnormalities.
  • Hypertension and hypercholesterolemia are common risk factors.

Observation:

  • A 65-year-old man presented with atypical chest pain and was diagnosed with multi-vessel giant coronary artery aneurysms via CT coronary angiography.
  • Initial coronary angiogram showed aneurysms but no obstructive disease; myocardial perfusion imaging was normal.

Findings:

  • Despite dual antiplatelet therapy (DAPT), the patient developed non-ST-elevation myocardial infarction due to occlusion of a previously aneurysmal LAD septal branch.
  • Switching to long-term oral anticoagulation resulted in clinical stability.

Implications:

  • Multi-modality imaging is crucial for diagnosing and evaluating coronary artery aneurysms.
  • Managing these aneurysms, especially when complicated by acute coronary syndrome, requires an individualized treatment strategy.
  • This case underscores the challenges in managing giant coronary artery aneurysms and the need for tailored therapeutic approaches.

Keywords:
Acute coronary syndromeCTCA, computed tomography coronary angiographyCase reportCoronary artery aneurysmDAPT, dual antiplatelet therapyKawasaki diseaseLAD, left anterior descending arteryMulti-modality imagingRCA, right coronary artery

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