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Diagnosis and Management of a Large RCA Aneurysm Treated With IVUS-Guided PCI Using Covered Stents
Pace S Wetstein1, Muhammad H Irfan2, Daniel I Ambinder3
1Lake Erie College of Osteopathic Medicine, Seton Hill, Greensburg, Pennsyvania, USA.
Background:
An 82-year-old man received a diagnosis of a large right coronary artery (RCA) aneurysm after subsequent visualization of an epicardial mass at the inferior aspect of the right ventricle on a chest CT scan.
Case Summary:
Our patient presented with an extensive vascular history with a growing RCA aneurysm. Intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention isolated the aneurysm, and 2 overlapping covered stents were successfully deployed, thereby restoring distal RCA perfusion.
Discussion:
RCA aneurysms are rare, and our patient was considered to be at high risk, which eliminated the possibility of surgical intervention. He ultimately underwent successful IVUS-guided percutaneous exclusion of the aneurysm by the placement of 2 overlapping covered stents.
Take-Home Messages:
IVUS is essential for coronary aneurysm intervention, particularly when standard angiography is insufficient because of the aneurysm size. This case illustrates the necessity of IVUS-guided imaging in place of traditional percutaneous coronary intervention for the management of coronary aneurysms.
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