Author + information
Patient initials or identifier number
Relevant clinical history and physical exam
A 56 years-old man was addressed to our cathlab because of large anterior (3/17), inferior and infero-lateral ischaemia (4.5/17). His cardiovascular risk factors included hyperlipidaemia and obesity. He had a medical history of abdominal aortic aneurysm. Physical examination found dyspnoea (class 2 NYHA ).
Relevant test results prior to catheterization
Nuclear stress test: Clinically positive for dyspnoea. Anterior ischaemia (3/17 segments). Inferior and infero-lateral ischaemia (4.5/17)
Relevant catheterization findings
Multivessel disease including :
- Long proximal left anterior descending artery stenosis
- Coronary aneurysm of the proximal circumflex with tight stenosis
After the heart team discussion, we have decided to treat the patients by PCI.
Coronary computed tomography angiography was performed and showed a severe lesion in the proximal neck of the circumflex aneurysm. The length of the aneurysm was 15 mm and the diameter was 7 mm.
Using a 6 French sheath right radial approach, an EBU 3.75 cannulated the left main. A BMW wire crossed the LAD lesions. LAD lesions were treated with 2 drug eluting stents.
After that, a BMW wire crossed the circumflex lesions. IVUS was performed and confirmed the presence of a severe and huge calcified lesion at the proximal neck of the aneurysm, and a severe lesion at the distal neck of the aneurysm.
Balloon predilatation was performed. A covered stent (Begraft 3 x 21 mm) failed to cross the lesion. The guiding catheter EBU 3.75 was removed and an AL2 was used to cannulate the left main. Then, a guidezilla was introduced in the AL 2. With this increased back up, stents crossed the lesion. A covered stent was implanted to exclude the aneurysmal lesion. Then PCI was completed with a drug eluting stent in the proximal circumflex.
Management of coronary aneurysm is under debate. PCI of an aneurysmal coronary lesion is safe and feasible. Assessment of the lesion by CT-scan and IVUS is useful to determine precisely the anatomy and the length of the lesions.
Implantation of a covered stent needs a high backup with the guiding catheter due to the large profile of these devices.