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Long-term Implications of Percutaneous Closure for Coronary Artery Aneurysm: A Case Report

This case report discusses a 47-year-old male patient with unstable angina and coronary artery aneurysm, highlighting the innovative treatment approach of percutaneous closure using a Jostent stent graft. Following initial success with TIMI 3 flow and minimal residual stenosis, the patient experienced a late in-stent thrombosis six months post-procedure, leading to an acute myocardial infarction. The case emphasizes the need for extended dual antiplatelet therapy and suggests that percutaneous closure may be a feasible management option for coronary aneurysms.

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Long-term Implications of Percutaneous Closure for Coronary Artery Aneurysm: A Case Report

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  1. Call for CASES Percutaneous closure of coronary artery aneurysm: long term implication Leszek D. Stachaczyk, MD Pawel Buszman, MD, FESC, FSCAI American Heart of Poland, Ustroñ, Poland & CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland

  2. Introduction Atherosclerosis of coronary artery may result in lumen narrowing or anurysm formation. Coronary anurysm enhances the risk of local thrombosis and/or peripheral embolisation. There is no established treatment for large coronary aneurysms.

  3. Description of the problem Case report: • Age 47 / male • Symptoms: Unstable Angina. • Medical History: non-Q myocardial infarction in 1994. • Risk factors: Hypercholesterolaemia, ex-smoker.

  4. Description of the problem • Concomitant treatment of coronary artery stenosis and aneurysm. • Percutaneous closure of left anterior descending coronary artery aneurysm with stent graft.

  5. Left anterior descending coronary artery aneurysm. Coronary angiography: LCA: LM-short, without narrowing LAD-proximal aneurysm (diam. ca 5-6mm), critical narrowings in med segment (90 and 75%) Cx-50-60% lesion in med segment. RCA: dominant, normal. LCA: RAO 30

  6. Intended strategy • Guiding catheter: Judkins Left 4, 7F • Stent graft Jostent 3.0x16mm on balloon 3.5x20mm Quantuum • Predilatation of LAD and placement of a PTFE – covered stent • Direct stenting to med Cx Technical data:

  7. Stenting • Administration of ticlopidine and ASA 2 days before procedure • Routine anticoagulation during procedure. • Predilatation and stentimplantation to LAD (3.0 / 16mm Jostent coronary stent graft with 16 atm) • Direct stenting to med Cx

  8. Acute Result • TIMI 3 flow after stentimplantation • Non significant residual stenosis • No complication

  9. Long-term sequel • Acute MI after 6 months (late in-stent thrombosis) • Successful thrombolysis combined with IIb/IIIa inhibitor.

  10. Summary • A 47 year old male withunstable angina was addmitted to the hospital for interventional diagnosis and treatment. • Coronary angiography showed a LAD eccentric aneurysmand double-vessel coronary artery disease (LAD, Cx). • The aneurysm and the lesion in proximal portion of LAD were treated with stent graft.The lesion more distally was treated with balloon angioplasty. Lesion in the Cx was stented. • Patient left hospital on combined antiplatelet therapy with aspirin and ticlopidine ordered for 3 months. • After 6 months patient suffered from anterior AMI caused by late in-stent thrombosis, which was successfully treated with thrombolysis and IIb/IIIa inhibitor.

  11. Message • Percutaneous coronary aneurysm closure with Jostent Graft is feasible and efficient. • The use of this stentrequires an extended course of double antiplatelet therapy.

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