Iatrogenic giant left anterior descending coronary artery pseudoaneurysm with contained perforation following percutaneous coronary intervention

Abstract

Giant iatrogenic coronary pseudoaneurysms are very rare. Left untreated, they may cause serious adverse outcome. We present a case of a male patient with recurrent NSTEMIs and coronary interventions who developed a large LAD artery pseudoaneurysm with contained rupture. He underwent excision of the large proximal LAD pseudoaneurysm, excision of the previous LAD stent, ligation of proximal LAD, and coronary artery bypass grafting with LIMA-LAD graft. He subsequently recovered and was stable on follow up. In conclusion, an aggressive surgical strategy, though difficult, is likely the best means of management for lasting benefit.

Systematic review of the evaluation and management of coronary pseudoaneurysm after stent implantation

“…Using the PRISMA methodology, 36 articles 1‐36 were identified that fulfilled criteria of PSA after stenting in an atherosclerotic lesion in the absence of concomitant infection (Figure 2). With the addition of the present case report (please see below), there are 37 well‐documented and reported coronary PSA cases (Table 1).…”

“…Pseudoaneurysm (PSA) formation is a rare but well‐known complication of coronary stenting 1‐36 . It develops after a perforation disrupts the integrity of the vessel wall but is contained by extravascular thrombosis, fibrosis, and pericardial constraint.…”