PMC6376528_01
(A) There is significant tortuosity of the right coronary artery (RCA) as well as a large aneurysm which partially fills with contrast (arrow). A large calcified rim can also be seen. (B) Positioning the drug-eluting stent. The distal marker can be seen just proximal to a large branch (arrow). (C) High-pressure postdilation of the covered stents to ensure apposition to the DES scaffold (3.5 mm non-compliant balloon at 18 atm). (D) Final angiography. The CAA has been successfully excluded with no residual flow into the aneurysm sac. CAA indicates coronary artery aneurysms; DES, drug-eluting stent.
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Urgent coronary angiography revealed a chronic total occlusion of the LAD, as well as a giant right CAA (Figure 1A). Due to the aneurysm length and presence of severe atherosclerotic disease, we elected to deploy a single 3.0 mm x 38 mm DES to span the neck of the aneurysm and cover the proximal and distal plaque (Figure 1B). The covered stents were postdilated with a 3.5-mm non-compliant balloon at 18 atm to ensure good apposition to the DES scaffold, which was confirmed by repeat IVUS (Figure 1C). The aneurysm was successfully excluded with no residual contrast flow into the aneurysm sac, and the proximal and distal coronary lesions were successfully treated with no residual stenosis (Figure 1D).
The previously placed covered stents were widely patent on this 10-month follow-up angiogram performed due to increased dyspnea.
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The covered stents remained widely patent with the aneurysm still excluded and the patient was resumed on medical therapy (Figure 2).