Stepwise Percutaneous Management of a Giant Coronary Pseudoaneurysm

Coronary pseudoaneurysms are rare but potentially life-threatening complications following coronary interventions. Their management presents significant technical challenges, particularly in frail patients with contraindications to surgery. This report describes the sequential percutaneous management of a giant acquired coronary pseudoaneurysm in a 74-year-old male with several comorbidities, including atrial fibrillation, aortic stenosis, and contraindication for open-heart surgery. Exclusion was achieved using covered stents, followed by left atrial appendage closure to allow withdrawal of anticoagulation. Moreover, during follow-up, transcatheter aortic valve implantation (TAVI) was performed due to severe symptomatic aortic stenosis. This case represents one of the largest coronary pseudoaneurysms reported in the literature and highlights the feasibility of an integrated imaging-guided percutaneous approach for the management of giant coronary pseudoaneurysms in high-risk patients. Left atrial appendage closure may have facilitated pseudoaneurysm thrombosis by enabling safe discontinuation of long-term anticoagulation, a hypothesis that warrants further investigation.