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Closure of giant coronary artery aneurysm with graft stent: a case report
Sevil Gülaşti1, Berk Mutlu2, Göksel Tuzcu3
1Department of Cardiology, Adnan Menderes University School of Medicine, Aydin, Turkey. drsevilonay@hotmail.com.
Insights
Giant coronary aneurysms are rare but can cause complications. This case highlights a successful treatment using a drug-eluting stent and graft stents for a large right coronary artery aneurysm.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary aneurysms (CAA) are increasingly detected due to advanced imaging.
- CAA are linked to adverse long-term outcomes, independent of atherosclerosis.
Purpose of the Study:
- To present a case of giant coronary artery aneurysm treatment.
- To discuss the management of rare coronary artery aneurysms.
Main Methods:
- A 59-year-old male with angina presented with a giant right coronary artery aneurysm.
- Diagnostic workup included echocardiography, Cardiac MRI, CT coronary angiography, and conventional coronary angiography.
- Treatment involved sequential stenting: a drug-eluting stent (DES) followed by two graft stents.
Main Results:
- A giant aneurysm (62x57 mm) originating from the proximal right coronary artery was identified.
- Successful exclusion of the aneurysm was achieved with a DES and two graft stents.
- Post-procedure angiography confirmed no contrast flow into the aneurysm.
Conclusions:
- Optimal treatment for coronary artery aneurysms is not well-defined due to a lack of guidelines.
- This case demonstrates a feasible endovascular approach for managing giant coronary aneurysms.
Background:
The presence of coronary aneurysm or ectasia has been associated with poor long-term outcomes, regardless of the presence of concomitant atherosclerotic coronary artery disease. The widespread use of new coronary imaging methods and the increase in coronary angiography applications in coronary artery disease have increased the frequency of rare coronary artery aneurysms (CAA).
Case Presentation:
A 59-year-old male patient applied to the cardiology outpatient clinic with angina that had been present for three to four months. The patient's electrocardiography was in normal with sinus rhythm and no signs of ischemia were observed. Transthoracic echocardiography revealed a52 × 47 mm mass, which was thought to be an aneurysm or cyst, causing compression on the right atrium. Cardiac MRI and computed tomography coronary angiography was performed and an aneurysm with dimensions of 62 × 57 mm, thought to originate from the right coronary artery (RCA), was observed. Coronary angiography of the patient showed a giant coronary aneurysm of the proximal segment of RCA. The patient was evaluated by the cardiac team.For treatment, a 3.5 × 48 mm Abbott Xience Pro DES was first implanted from the proximal normal coronary artery segment to the distal normal segment beyond the aneurysm, creating a stable platform for graft stent placement. Two consecutive 4.0 × 20 mm Papyrus-Biotronik graft stents were then implanted into this DES without leaving any gaps. Post-procedurally, no contrast passage into the aneurysm was observed.
Conclusion:
Because of the absence of available guidelines, the optimal treatment method for coronary artery aneurysms remains uncertain.
