Giant pseudoaneurysm following percutaneous coronary intervention: a case report

A coronary pseudoaneurysm (CPA) is defined as a rupture of the coronary artery wall where blood is encapsulated by surrounding pericardial tissue, thrombus, or fibrous tissue, forming a fluid-filled sac lacking normal vascular walls. While pseudoaneurysms can develop spontaneously, they most commonly occur following coronary intervention procedures, such as percutaneous coronary intervention. Causes include excessive balloon or stent usage, high-pressure balloon dilation, and arterial wall damage from coronary atherosclerotic resection or laser angioplasty. Although asymptomatic in many cases, a ruptured CPA can lead to life-threatening acute cardiac tamponade. Notably, postoperative mortality in some PCI patients may result from both malignant arrhythmias and recurrent myocardial infarction, with CPA rupture being a contributing factor. This case report describes a patient who developed a massive pseudoaneurysm 1 year after undergoing chronic coronary occlusion lesion recanalization. Through surgical review, we analyze the etiology, discuss subsequent interventions, and highlight clinical lessons to provide guidance for managing such complex cases.