Defusing a ticking time bomb: percutaneous intervention for a giant coronary pseudoaneurysm - a case report

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Giant coronary pseudoaneurysms (PSAs) are rare cardiovascular emergencies.
• Surgical management is traditional, but carries significant risks.
• Percutaneous intervention offers a less invasive alternative.

Purpose of the Study:

• To report a case of successful percutaneous treatment of a giant coronary pseudoaneurysm.
• To demonstrate the utility of covered stents in managing this rare condition.
• To emphasize the role of multi-modality imaging and a multidisciplinary approach.

Main Methods:

• A 62-year-old male with NSTEMI and cardiogenic shock presented with a giant LM-LAD PSA.
• Multi-modality imaging (TTE, CTCA) characterized the PSA.
• Percutaneous coronary intervention with covered stent deployment under IVUS guidance was performed.

Main Results:

• Successful percutaneous closure of the giant LM-LAD PSA was achieved.
• Thrombus formation within the PSA cavity was observed post-procedure.
• Complete PSA resolution was confirmed at 3-month follow-up echocardiography.

Conclusions:

• Percutaneous treatment of giant coronary PSAs using covered stents is feasible.
• Multi-modality imaging and a HEART team approach are crucial for optimal management.
• This approach can avoid surgical complications and achieve favorable outcomes.