Author + information
- Received April 7, 2017
- Accepted April 20, 2017
- Published online July 3, 2017.
- Alberto F. Cereda, MDa,b,∗ (, )
- Gianluca Tiberti, MDa,
- Isidoro G. Pera, MDa,
- Edoardo Cantù, MDa,
- Luca A. Ferri, MDa,
- Stefano Savonitto, MDa and
- Luigi Piatti, MDa
- ↵∗Address for correspondence:
Dr. Alberto F. Cereda, ASST Manzoni, Via Ghislanzoni 22, 23900 Lecco, Italy.
- coronary ectasia
- covered stent(s)
- giant coronary aneurysm
- multiple overlapping stenting
- stove-pipe technique
A 62-year-old man with known coronary artery ectasias was referred to our center in 2001 for ischemic symptoms and mild inferior hypokinesis on echocardiography. Coronary angiography showed diffused coronary artery ectasias with aneurysmatic appearance of the proximal and mid left circumflex coronary artery without stenotic lesions (Figure 1A); a conservative medical approach with aspirin and warfarin was advised. The patient did well on medical therapy thereafter until December 2016, when he was admitted with an inferolateral ST-segment elevation myocardial infarction. Emergency angiography showed the evolution of the mid left circumflex coronary artery lesion into a giant aneurysm with distal thrombotic embolization causing occlusion of the vessel (Figures 1B and 1C, Online Video 1). Because of the huge amount of thrombus, rheolytic coronary mechanical thrombectomy was chosen to remove the occluding clot, with ST-segment resolution (Figures 1D and 1E). One week later, despite triple therapy with aspirin, clopidogrel, and warfarin, recurrent coronary thrombosis occurred, and balloon angioplasty was needed to bridge the patient to the following definitive coronary intervention. The procedure was performed via right radial access, using a 6-F extra backup 3.5 catheter. An intravascular ultrasound pre-evaluation of the distal and proximal landing zones of the giant aneurysm was undertaken, and 4 PK-Papyrus stents were deployed in sequence from the distal to the proximal edge, with a 4 to 5 mm of overlap (Figures 1F1, 1F2, 1G1, and 1G2); proximal and distal landing zones were post-dilated with noncompliant balloons, with good angiographic results (Figure 1H, Online Video 2). Intravascular ultrasound grayscale and ChromaFlo (Philips, Volcano, San Diego, California) imaging (Online Video 3) highlighted the successful apposition of the covered stents and the complete sealing of the aneurysm, also visible on echocardiography (Figure 1I, Online Video 4). At 4 months, the patient is doing well on therapy with aspirin and clopidogrel. We succeeded in sealing a giant coronary artery aneurysm, with good angiographic and clinical outcomes by means of a novel transradial intravascular ultrasound–guided percutaneous technique.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 7, 2017.
- Accepted April 20, 2017.
- 2017 American College of Cardiology Foundation