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Stent-Associated Coronary Artery Aneurysm Treated With Interposition Graft and Branch Reimplantation
Jose L Diz Ferre1, Mahmoud Alshneikat1, Faisal G Bakaeen1
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Coronary artery aneurysms have an incidence of 0.3% to 5.3% following percutaneous transluminal coronary angioplasty.
Case Summary:
A 75-year-old woman presented with dyspnea on exertion and chest discomfort. In 2004 she underwent percutaneous coronary intervention to the left anterior descending artery (LAD) and, in 2010, a ST-segment elevation myocardial infarction was treated with another LAD stent. On this admission, catheterization revealed a large proximal LAD coronary aneurysm at the site where the last stent was placed. She underwent successful LAD aneurysm repair with end-to-end saphenous vein graft interposition and end-to-side bypass to the diagonal branches.
Discussion:
The most common surgical procedures are ligation and coronary artery bypass graft. In our case, the diagonal branches were too small to perform epicardial bypasses.
Take-Home Messages:
Repair of coronary aneurysm with interposition of saphenous vein graft re-establishes flow to the main vessel and tributaries. Adequate exposure and meticulous techniques are essential for success.
