Extensive coil embolization of a giant coronary artery aneurysm in an octogenarian: a case report

Abstract

Background Coronary artery aneurysms (CAA) are often diagnosed incidentally on coronary angiography or imaging modalities done for other reasons. ‘Giant’ CAA by definition exceeds 20 mm in diameter or four times the diameter of normal coronary artery. The management of patients with CAAs is challenging due to poorly understood mechanism, variable presentation, and lack of clear-cut societal recommendations. Though conservative management is preferred in asymptomatic patients, massive size or interval growth may make intervention necessary. Case summary We describe a case of successful coil embolization of a giant coronary aneurysm in an elderly 84-year-old male. Patient, who presented for a follow-up computed tomography angiography to evaluate a previously repaired abdominal aortic aneurysm 2 years back, was found to have interval growth of right coronary artery aneurysm from 4 cm in diameter to 7 × 8 cm in its greatest dimensions. The rationale for treatment was to prevent sudden death from continued growth and eventual rupture of aneurysm in addition to potential risk of thromboembolism and compression of adjacent structures. Discussion This case demonstrates the safe and successful use of extensive coil embolization technique to treat a ‘giant’ CAA in an elderly patient when surgical risks were prohibitive.

Globe in the Heart: A Rare Case Report of Giant Coronary Artery Aneurysm

“…However, the lack of purpose-specific devices, high thrombus burden, and challenges of covered stent delivery make percutaneous coronary intervention (PCI) very difficult. 9 Favorable outcomes of PCI in asymptomatic patients with CAA are limited to small case series only. Intravenous immunoglobulin use in patients with Kawasaki disease has been shown to reduce CAA formation and lower incidences of major adverse cardiovascular events.…”

Coils embolization use for coronary procedures: Basics, indications, and techniques

“…Coronary artery aneurysms (CAA) are one of the elective indications for coil embolization. 35,36 In addition, coils can be considered in an acute setting for a ruptured pseudoaneurysm. 37 CAA can be found up to 5% of patients who have undergone coronary angiography.…”

Coronary artery aneurysm: A review

“…Since previously published data[ 51 - 53 ], the incidence of rupture of CAA was dramatically decreased[ 54 ]. An excessively enlarged CAA may compress the surrounding adjacent cardiopulmonary structures like the right atrium[ 55 ], the right ventricular wall[ 55 ], the pulmonary artery and the tricuspid valve[ 56 ].…”