Giant coronary artery aneurysm of the left main treated with a covered stent: a case report

Abstract

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.

Intravascular ultrasound-guided percutaneous exclusion of a complicated coronary artery aneurysm presenting as ST-segment elevation myocardial infarction

“…CAA is defined as a local dilatation in a coronary artery ≥1.5 times the diameter of adjacent healthy segments, mainly due to atherosclerosis, with an incidence <1%. CAAs constitute a rare substrate (0.15-1.4%) of STEMI [1][2][3]. The indication for treatment is controversial due to the limited available data.…”

“…PK Papyrus and Graftmaster (Fig. 1f, left and right, respectively) are the most widely used stent graft systems to exclude CAA [1][2][3], with technical limitations due to their high crossing profile and rigidity, for which support techniques are often required [1].…”