A Case of a Multistent Scaffold Approach for Treatment of a Coronary Artery Aneurysm
Abbreviation
- LAD
left anterior descending coronary artery
Case Description
A 74-year-old man with a left anterior descending coronary artery (LAD) aneurysm who was not a surgical candidate was referred to the catheterization laboratory because of concerns for rapid aneurysmal expansion. Coronary computed tomography angiography (Fig. 1) revealed a large, proximal LAD aneurysm 1.6 cm in diameter, with calcified and soft plaque both proximal and distal to the aneurysm. Angiography revealed that the proximal LAD had moderate (60%) stenosis, followed by a large, fusiform aneurysm. There was severe (80%-90%) stenosis just distal to the aneurysm, with Thrombolysis in Myocardial Infarction grade 2 flow in the rest of the LAD (Fig. 2).
Citation: Texas Heart Institute Journal 52, 1; 10.14503/THIJ-25-8573
Citation: Texas Heart Institute Journal 52, 1; 10.14503/THIJ-25-8573
Technique
Via radial access, an XB 3.5 guide catheter was used. Using a 5.5F GuideLiner guide catheter (Teleflex Incorporated) for support, a Runthrough NS guidewire (Terumo Interventional Systems) and Turnpike LP microcatheter (Teleflex Incorporated) were passed along the aneurysm into the distal LAD. The LAD was predilated on both sides of the aneurysm with a 2.75 × 20-mm semicompliant balloon. Intravascular ultrasonography imaging was performed to obtain vessel, lesion, and aneurysm sizing information. A 4.0 × 48-mm drug-eluting stent was deployed across the aneurysm, landing within the nonaneurysmal portions of the LAD to provide a scaffold for the covered stents. The stent was postdilated with 5.0 × 20-mm and 5.0 × 12-mm noncompliant balloons. Next, 5.0 × 26-mm and 5.0 × 20-mm PK Papyrus–covered stents (Biotronik) were deployed within the previously placed drug-eluting stent scaffold and postdilated with a 5.0 × 15-mm noncompliant balloon (Fig. 3). Final intravascular ultrasonography imaging was performed that showed well-apposed and well-expanded stents without any evidence of edge dissection. Coronary computed tomography angiography performed a month later showed a widely patent stent that had fully occluded the aneurysm (Fig. 4)
Citation: Texas Heart Institute Journal 52, 1; 10.14503/THIJ-25-8573
Citation: Texas Heart Institute Journal 52, 1; 10.14503/THIJ-25-8573
Comment
The management of coronary artery aneurysms is complicated1 and often requires an individual approach based on numerous patient factors. This article presents a unique interventional method using a stent scaffold for the management of a large, fusiform aneurysm that effectively seals off the aneurysmal section while preserving distal flow.
Preprocedural coronary computed tomography angiography outlines the left anterior descending coronary artery (LAD) aneurysm.
Preprocedural angiogram shows the left anterior descending coronary artery aneurysm.
Supplemental motion image available for Figure 2
Post–stent deployment angiogram outlines the sealing of the aneurysm.
Supplemental motion image available for Figure 3
Postprocedural coronary computed tomography angiography outlines the widely patent stent in the left anterior descending coronary artery (LAD) and sealed-off aneurysm.
Contributor Notes
