Spontaneous right coronary artery pseudoaneurysm

Abstract

A 67-year-old man who had no history of coronary artery disease was found to have electrocardiographic abnormalities. Coronary angiography showed a proximal coronary artery aneurysm and total occlusion of the distal right coronary artery. He underwent coronary artery bypass grafting and repair of the right coronary artery aneurysm. The pathology of the resected aneurysm wall was compatible with a diagnosis of coronary pseudoaneurysm. Spontaneous coronary artery pseudoaneurysm is a rare condition that has the potential risk of rupture or ischemia. Surgical repair and adequate coronary revascularization are reasonable for a possible coronary artery pseudoaneurysm.

Giant Coronary Artery Aneurysms: Review and Update

“…2,4-6,9,10,12-14, [16][17][18][19]21,[23][24][25]27,28,30,32,[34][35][36][37]39,40 Similarly, the usual cause of giant CAAs is atherosclerosis, but other causes have been described. Keyser and colleagues 30 presented a compilation of 28 cases of giant CAA (exceeding 50 mm in size) reported over a period of 49 years.…”

“…Pseudoaneurysms are dissections or perforations: there is loss of vessel-wall integrity, with damage to the adventitia, perivascular tissue, or both. 8,12,18,19,24,32,34 Pseudoaneurysms often occur after catheter-based interventions, as a result of traumatic dissection or perforation of the coronary artery, and they rarely occur spontaneously. 8,12,17,24,32,34,43 Our illustrative case is unusual because the aneurysm occurred in the left system and was markedly large, at 70 × 40 mm.…”

“…4,7,12,17,19,21,22,32,41 However, it is difficult to determine by coronary angiography whether an aneurysm is true or false. 8,17,24,34 The coronary angiogram is a "luminogram" that does not define the 3 layers of vessel wall that differentiate true aneurysms from pseudoaneurysms. 17,24,34 The information obtained via coronary angiography can be refined by intravascular ultrasound, which can provide additional information to differentiate a true aneurysm from a false aneurysm.…”

“…8,17,24,34 The coronary angiogram is a "luminogram" that does not define the 3 layers of vessel wall that differentiate true aneurysms from pseudoaneurysms. 17,24,34 The information obtained via coronary angiography can be refined by intravascular ultrasound, which can provide additional information to differentiate a true aneurysm from a false aneurysm. 7,12,17,19,24,[32][33][34]41 Intravascular ultrasonography provides transmural images of the coronary arteries that include information on the composition of the lumen and the arterial wall structure.…”

“…17,24,34 The information obtained via coronary angiography can be refined by intravascular ultrasound, which can provide additional information to differentiate a true aneurysm from a false aneurysm. 7,12,17,19,24,[32][33][34]41 Intravascular ultrasonography provides transmural images of the coronary arteries that include information on the composition of the lumen and the arterial wall structure. 17,24,33 Intravascular ultrasonography was not performed on our patient, so we could not definitively identify the layers involved in the aneurysmal segment.…”