Coil embolization for distal left main aneurysm: A new approach to coronary artery aneurysm treatment

Abstract

Coronary artery aneurysm is an uncommon disease, whose natural history and therapeutic approach are still controversial: medical therapy, surgical revascularization with or without aneurysm ligation or excision, and endovascular exclusion with membrane covered stents are all accepted and viable options, according to anatomic characteristics. Intracranial aneurysms are adequately treated by means of coil embolization, an option that, to our knowledge, has never been tested in coronary interventions. We report the first case of a coronary aneurysm involving the distal left main and the proximal left anterior descending artery treated with "stent-assisted" coil embolization.

Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment

“…Another percutaneous option in the management of wide-necked aneurysms is coil insertion (134, 135); however, experience is needed to perform these interventions. Also, coil herniation can lead to the occlusion of the parent vessel; therefore, stent-assisted techniques are preferred.…”

“…Also, coil herniation can lead to the occlusion of the parent vessel; therefore, stent-assisted techniques are preferred. Another pitfall is the risk of aneurysm rupture during the manipulation of the microcatheter, coils, or wires (134). …”

Percutaneous Closure of a Coronary Artery-to-Vein Graft Anastomotic Pseudoaneurysm Presenting as Acute Coronary Syndrome after Recent Coronary Artery Bypass Grafting

“…Rarely, they form early in the postoperative course. 13 In 1975, Riahi and colleagues 2 first described the phenomenon of an eurysm formation in a saphenous veintocoronary ar tery graft after CABG. A pseudoaneurysm is defined as a defect in the arterial wall that causes extravasation of blood into a contained extraluminal space, whereas Figure 3.…”

“…As is the case with percutaneous repair of other vascular aneurysms, coronary aneurysm rupture is potentially devastating, and extreme caution should be exercised while manipu lating microcatheters and coils within the aneurysmal sac. 13 In stentassisted coil embolization, another con sideration is the risk of instent restenosis or thrombosis and subsequent coronary ischemia.…”

Left main aneurysm and what’s next?

“…The first case reports about coronary artery bypass graft (CABG) in LMA can be found in the 1970s [12]. Currently, several types of treatment, such as surgical removal of the aneurysm and CABG, or isolated CABG, stent graft or coil can be applied [13–17]. A lack of surgical standards triggers the need to search for new methods such as removal of the aneurysm and replacement with a new artery or wire [18–20].…”