Navigating Complex Anatomy: Coil Embolization of a Large LAD Aneurysm
Presenter
Jonathan D Meyer, MD, CCNI/Cardiology/Community Hospital, Munster, IN, Chicago, IL
Jonathan D Meyer, MD, CCNI/Cardiology/Community Hospital, Munster, IN, Chicago, IL
Title:
Navigating Complex Anatomy: Coil embolization of a large LAD aneurysm
Introduction:
Coronary aneurysm is associated with poor long-term prognosis. Due to their relatively rarity and heterogeneous presentation, no randomized control data exists regarding optimal treatment. We present the percutaneous treatment of a giant LAD coronary aneurysm for chronic stable angina.
Clinical Case
A 53-year-old man presents with acute chest pain and inferior ST elevation MI. He underwent angiography which showed an acute occlusion of an OM branch, in the setting of complex coronary anatomy, including high grade stenosis of the mid LAD, a giant proximal LAD aneurysm, and intermediate disease with ectasia of the right coronary artery disease. He was treated with balloon angioplasty of the OM and subsequent IABP placement for surgical referral. After meeting with the cardiac surgeons, patient left against medical advice, and did not seek medical attention for over three years. During that time, he experienced daily CCS 3 angina which progressively worsened until he again sought outpatient cardiology consultation. After extensive discussion with the patient, the shared decision was to undergo percutaneous revascularization of the LAD and exclusion of the LAD aneurysm. A coronary CT scan was performed for pre-procedure planning which showed a 13x14mm aneurysm with a 10mm neck at the base. Pre-procedure TTE showed preserved LV function. 7F right radial access was obtained, and IVUS guided bifurcation PCI of the mid to distal LAD and diagonal branch was performed using drug eluting stents. PCI of the LM-LAD was performed with a drug eluting stent. A microcatheter was then advanced through the stent struts and into the aneurysm. Stent-assisted coiling was completed until dense packing was obtained. Angiography confirmed exclusion of the aneurysm. The patient tolerated the procedure well, and he was discharged the next morning.
Discussion
Coronary aneurysm can be clinically challenging. As there is little robust clinical data, it is vital to tailor treatment options to both the clinical presentation as well as the patient themselves. This case illustrates a successful percutaneous treatment of a giant coronary artery aneurysm using stent-assisted coiling.