IVUS-Guided Exclusion of Right Coronary Artery Aneurysm in Multivessel Coronary Artery Disease Using Hybrid Stenting

Optimal management of coronary aneurysms remains controversial, especially in multivessel disease, where surgical revascularization is often considered.

A 65-year-old man with prior percutaneous coronary intervention of the left anterior descending artery (LAD) presented with worsening exertional angina. Angiography demonstrated severe mid-LAD stenosis proximal to a previously implanted stent and a large saccular aneurysm (8.55 × 7.88 mm) in the proximal right coronary artery with significant distal stenosis. Coronary artery bypass grafting was recommended; however, the patient declined surgery. Percutaneous coronary intervention of the mid-LAD was performed followed by a hybrid percutaneous approach for right coronary artery aneurysm exclusion, with initial drug-eluting stent implantation and subsequent covered stent deployment under intravascular ultrasound (IVUS) guidance.

This case highlights the role of IVUS and technical challenges in effective coronary aneurysm exclusion via hybrid stenting technique.

IVUS-guided hybrid stenting may represent a feasible percutaneous treatment strategy for selected coronary artery aneurysms.