Background Coronary artery aneurysms of the left main represent a small subset of coronary artery disease and has the potential to evolve in a fatal outcome. Because of its rare entity, large data are lacking and therefore treatment guidelines are missing. Case summary We describe a case of a 56-year-old female with a past medical history of spontaneous dissection of the distal descending left artery 6 years before. She presented to our hospital with a non-ST elevation myocardial infarction and coronary angiogram showed a giant saccular aneurysm of the shaft of left main coronary artery. Given the risk of rupture and distal embolization, the heart team decided to go for a percutaneous approach. Based on a pre-interventional 3D reconstructed CT scan and guided by intravascular ultrasound, the aneurysm was successfully excluded with a 5 mm papyrus covered stent. At 3-months and 1-year follow-up the patient is still asymptomatic and repeat angiographies showed full exclusion of the aneurysm and absence of restenosis in the covered stent. Discussion We describe the successful IVUS and 3D reconstructed CT scan guided percutaneous treatment of a giant left main shaft coronary aneurysm with a papyrus covered stent with excellent 1-year angiographic follow-up showing no residual filling of the aneurysm and no stent restenosis.

BackgroundThe postdischarge prognostic implication of periprocedural myocardial injury in patients undergoing percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) remains scarcely studied.AimsThe aim of this study is to assess the prognostic value of periprocedural myocardial injury, defined by increased high-sensitive troponin T (hs-TnT) levels according to updated guidelines, after CTO PCI.MethodsBetween September 2011 and April 2020, 726 patients undergoing CTO PCI at 2 Belgian referral centres were prospectively included and divided into 4 groups based on postprocedural hs-TnT levels (unelevated; ≥5 times the upper limit of normal (ULN); ≥35 times the ULN; ≥70 times the ULN). Postprocedural hs-TnT levels were subsequently related to patient and procedural characteristics, 1-year major adverse cardiac and cerebrovascular events (MACCE; excluding in-hospital MACCE) as well as 1-year mortality.ResultsAt 1 year follow-up (FU), elevated hs-TnT≥5 times and ≥35 times the ULN were associated with higher MACCE rates (p=0.001; p=0.007, respectively). In addition, they also resulted in a higher 1-year mortality rate (p=0.009;p=0.021, respectively). Patients with increased hs-TnT≥5 times the ULN (35% of patients) more frequently had signs of more advanced atherosclerotic disease (previous CABG p<0.001; stroke p≤0.001 and peripheral vascular disease p<0.001) and had higher procedural complexity (Japanese CTO Score p=<0.001, stent length>48 mm p<0.001, procedure time p<0.001). Antegrade wire escalation did not result in lower event rate of postdischarge MACCE compared with the other CTO crossing techniques combined (p=0.158).ConclusionPeriprocedural myocardial injury was associated with a significantly higher rate of MACCE and all-cause mortality after 12 months of FU.