A rapidly growing coronary pseudoaneurysm




Abstract


Little is known regarding the evolution of coronary aneurysms. We report on a rapidly growing coronary pseudoaneurysm with the aim to underline the reasons for rapid coronary aneurysm enlargement and the different therapeutics options available to face this rare clinical condition.


A 73-year-old man with hypertension, dyslipidemia and type 2 diabetes mellitus presented to our unit with recurring effort angina. Ten years before he had undergone PCI with bare metal stent (BMS) implantation to the mid left anterior descending (LAD) and left circumflex (LCx) arteries. Stress echocardiogram showed the presence of a large area of reversible ischemia of the anterior left ventricular (LV) wall with normal LV function at rest. Coronary angiography documented a critical in stent restenosis (ISR) of the proximal and mid LAD, which was successfully treated using drug eluting balloons ( Fig. 1 , Panels 1A and 1B).




Fig. 1


Panel 1A: Coronary angiogram showing in stent restenosis (ISR) of the proximal LAD (yellow arrow) At the bottom right, particular underlining the position of the BMSs implanted ten year before at the proximal LCx and proximal LAD. No peristent dilatation can be seen.

Panel 1B: angiogram showing the result of ISR treatment with drug eluting balloon. Once again, no suggestion of peristent dilatation can be seen.

Panel 2: Angiogram showing an outward protrusion filled with contrast, connected to the proximal segment of the LCx, where a BMS had been implanted ten years before. In stent haziness, distal to the dilatation inflow, can be seen. Neither IVUS nor OCT allowed definition of the nature of the dilatation. OCT confirmed the presence of in stent thrombosis (cross section at the bottom, left side).

Panel 3: Contrast filling of the dilatation was clearly reduced after implantation of a DES inside the BMS.

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Nov 14, 2017 | Posted by in CARDIOLOGY | Comments Off on A rapidly growing coronary pseudoaneurysm

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