PMC9972523_01
(A) Ectasia of the left main coronary artery 6 years before. (B + C) Development to the left main coronary artery aneurysm, respectively, in right and left caudal view. (D + E) CT reconstruction of left main coronary artery.
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At that time, balloon angioplasty was used to treat the SCAD with good results, and there was already a slight ectasia of the left main visible (Figure 1A). No coronary artery stenoses or dissection were present. (Figure 1B and C) The aneurysm and embolism accompanied by it were the presumed cause of the NSTEMI. An additional CT coronary angiography was performed to better define the anatomy prior to intervention (Figure 1D and E).
(A) Immediate angiographic results following covered coronary stent placement with remaining dye in aneurysm in right caudal view. (B + C) Intravascular ultrasound images showing the covered stent (arrow) in the aneurysm (*) and the edge of the stent with a remaining neck to the aneurysmal cavity (#).
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After post-dilatation with a 5.5 mm NC balloon, angiography and IVUS demonstrated incomplete coverage of the distal part aneurysm at the level of the bifurcation, with limited retrograde filling of the aneurysm by a small gap distal from the stent close to the bifurcation (Figure 2).
Angiographic images of the left main coronary artery at 1 year follow-up showing an excellent result of the percutaneous procedure without a residual neck nor retrograde filling of the aneurysm. (A) Right caudal view. (B) Left caudal view.
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CA showed an excellent result of the PCI without a residual neck or retrograde filling of the aneurysm and without obvious restenosis (Figure 3). Consequently, additional coiling was not necessary.