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Published on: July 7, 2013
Percutaneous intervention of a giant native coronary artery aneurysm using self-expanding stents
Abhishek Chaturvedi1, Dan Haberman1, Ron Waksman1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Insights
Percutaneous coronary intervention (PCI) using covered stents successfully excluded a large coronary artery aneurysm (CAA) in a patient unsuitable for surgery. This demonstrates PCI as a viable alternative for complex CAA management.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary artery aneurysms (CAAs) lack standardized treatment guidelines, posing therapeutic challenges.
- Percutaneous coronary intervention (PCI) is infrequently used for CAAs, particularly giant ones, with surgery often presumed superior.
Observation:
- A 66-year-old woman with a symptomatic, enlarging right coronary artery aneurysm and complex medical history was treated.
- Initial PCI with a Gore Viabahn ePTFE-covered stent experienced endoleak, requiring additional stent deployment.
Findings:
- Intravascular ultrasound (IVUS) guided precise deployment of additional nitinol self-expanding stents.
- Successful exclusion of the coronary artery aneurysm was achieved using the covered stent technique.
Implications:
- This case highlights the technical feasibility of PCI for complex CAAs using Gore Viabahn ePTFE-covered nitinol stents.
- PCI may serve as a potential alternative treatment for symptomatic CAAs in patients who are poor surgical candidates.
Abstract:
In the absence of standardized management guidelines, coronary artery aneurysms (CAAs) present therapeutic challenges. Percutaneous coronary intervention (PCI) is rarely explored, especially in giant aneurysms with persistent angina, where surgery might be presumed as a preferred option. We describe the technical aspects and feasibility of PCI using Gore Viabahn expanded polytetrafluoroethylene (ePTFE)-covered nitinol self-expanding stents in a 66-year-old woman with a complex medical history and an enlarging, symptomatic right coronary artery aneurysm. The case was complicated by endoleak after the first stent, but intravascular ultrasound guidance enabled the precise deployment of additional stents, resulting in the successful exclusion of the aneurysm. This case demonstrates steps to successful CAA PCI with Gore Viabahn ePTFE-covered nitinol self-expanding stents and emphasizes that in unsuitable surgical candidates, PCI might be a potential alternative for symptomatic CAAs.
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