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In the absence of standardized management guidelines, coronary artery aneurysms (CAAs) present therapeutic challenges. Percutaneous coronary intervention (PCI) is rarely explored, especially in giant aneurysms with persistent angina, where surgery might be presumed as a preferred option. We describe the technical aspects and feasibility of PCI using Gore Viabahn expanded polytetrafluoroethylene (ePTFE)-covered nitinol self-expanding stents in a 66-year-old woman with a complex medical history and an enlarging, symptomatic right coronary artery aneurysm. The case was complicated by endoleak after the first stent, but intravascular ultrasound guidance enabled the precise deployment of additional stents, resulting in the successful exclusion of the aneurysm. This case demonstrates steps to successful CAA PCI with Gore Viabahn ePTFE-covered nitinol self-expanding stents and emphasizes that in unsuitable surgical candidates, PCI might be a potential alternative for symptomatic CAAs., (© 2024 Wiley Periodicals LLC.)

The development and progressive enlargement over time of multiple saccular coronary artery aneurysms (CAA) after implantation of everolimus-eluting stent and bioresorbable vascular scaffolds (BVS) have been reported. CAA was successfully excluded by two overlapped covered stents expanded inside a long metallic drug-eluting stent to avoid dislodgment at the overlap point. Optical coherence tomography (OCT) was repeatedly performed to monitor CAA expansion and to guide treatment through precise measurement of aneurysm length and vessel size at the landing zone. At 10-month follow-up, coronary computed tomography angiography showed persistent CAA exclusion. To the best of our knowledge, this is the first report of this technique to exclude a long CCA segment., (© 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Background: Coronary artery aneurysms (CAA) are seen in 1-5% of angiograms. Aneurysmal coronary disease has been thought to be a variant of atherosclerotic coronary artery disease (CAD) in most patients, but this has not been systematically studied., Methods: To better understand the pathophysiology of CAA, we reviewed the cardiac catheterization films of 403 patients with ascending thoracic aortic aneurysms and 74 patients with abdominal aortic aneurysms (AAA) who underwent surgery for their aortic aneurysms at our institution. Coronary aneurysms had diameters 1.5-fold that of a reference segment., Results: The incidences of CAA in patients with ascending aneurysms and AAA were 17% and 16% respectively (P = 0.92). CAAs in the ascending group were larger (mean diameter 5.9 vs. 5.0 mm, P = 0.12) with larger reference vessel size (3.1 vs. 2.6 mm, P = 0.03). CAAs in the patients with ascending aneurysms were less likely to be CAD-associated within the same vessel (12% vs. 75%, P < 0.001). This difference remained significant after controlling for the presence of generalized CAD. No other differences in CAAs between the two groups were found. Within the ascending aneurysm group, the only clinical variable independently associated with CAA was bicuspid aortic valve (OR 0.47, 95% confidence interval 0.25-0.89, P = 0.02). The majority of patients with CAA in the ascending aortic aneurysm population did not have CAD or any other previously identified cause of CAA., Conclusions: There is a high incidence of CAA in patients with aortic aneurysms. In patients with ascending aortic aneurysms there is likely a mechanism distinct from CAD that causes CAAs., (© 2014 Wiley Periodicals, Inc.)

Vascular Ehlers-Danlos syndrome is a rare connective tissue disorder associated with arterial dissection or rupture. Percutaneous coronary intervention (PCI) is often critical in patients with this syndrome because their coronary arteries are prone to dissection, enhancing the risk of stent borders dissection when conventional stent deployment pressures are used. Coronary artery bypass graft (CABG) treatment for these patients may also raise concerns because the left internal mammary artery is probably friable. Therefore, coronary artery revascularization in vascular Ehlers-Danlos syndrome either using PCI or CABG is challenging due to the arteries friability. A small number of cases have been published describing the friability of the vessels and associated complications; nevertheless, the optimum treatment remains unclear. We report the case of a 54-year-old woman treated successfully with PCI and CABG in two different acute coronary syndrome episodes, in which specific technical issues related to both procedures were decisive., (Copyright © 2011 Wiley Periodicals, Inc.)

Spontaneous coronary artery dissection (SCAD) is a rare cause of myocardial ischemia. Multivessel SCAD is much rarer than single vessel involvement and acute coronary syndrome remains the most common clinical presentation of a patient with SCAD. It predominantly occurs in association with atherosclerosis or in the absence of atherosclerosis. We, hereby, present a case of spontaneous multivessel coronary artery dissection in a 35-year-old male patient presenting with chest pain and ventricular tachycardia following emotional stress and discuss the etiology and treatment options., (Copyright © 2011 Wiley-Liss, Inc.)

Coronary artery aneurysm (CAA) is an uncommon and often incidental finding on coronary angiography but can present with symptoms related to myocardial ischemia. The most common etiology is atherosclerosis, accounting for over 50% of cases, but CAAs can also be congenital or secondary to percutaneous coronary artery revascularization procedures, inflammatory arterial diseases, connective tissue disorders, and perhaps drug-eluting-stent (DES) implantation. A current lack of uniform guidelines for their therapeutic management, especially in the setting of DES, leaves their optimum treatment somewhat controversial. Polytetrafluoroethylene-covered stents have gained popularity in recent years for percutaneous treatment of CAAs; however, their failure to endothelialize is associated with increased risk of thromboocclusive events. We describe two symptomatic patients presenting with large CAAs, one forming after DES implantation, that we treated using the double-stent method, in which one stent is placed within another. The intent is to reduce stent permeability across the aneurysm and promote blood stasis within it, thereby encouraging aneurysm thrombosis and meanwhile preserving the stents' ability to endothelialize. The immediate angiographic result revealed markedly reduced filling of the aneurysms and aneurysm thrombosis was later confirmed at follow-up. Both patients have remained asymptomatic during at least 9 months of follow-up. To the best of our knowledge, this is the first case report describing the use of the double-stent method as an alternative to treat CAAs percutaneously., (Copyright © 2011 Wiley-Liss, Inc.)

The case of a patient presenting with acute inferior ST-elevation myocardial infarction is described. Emergent coronary angiography of the right coronary artery revealed what appeared to be the abrupt drainage of contrast into a large, peculiar cavity or chamber. Echocardiography and cardiac computed tomography demonstrated a giant right coronary aneurysm in the right coronary artery that gave the impression of a "fifth heart chamber." The patient underwent successful surgical resection of the aneurysm. Diagnostic and treatment approaches to giant coronary aneurysms are discussed., (Copyright © 2011 Wiley-Liss, Inc.)

Coronary artery aneurysm is an unusual finding at coronary arteriography. We present a case of acute myocardial infarction and a giant aneurysm of the left circumflex coronary artery (CX) in a 70-year-old male with hypertension. The culprit lesion was a thrombus occupying the aneurysm and the distal CX. By an unconventional manoeuvre the thrombus was aspirated via the 7 French guiding catheter. After stent implantation in the distal CX a thrombolysis in myocardial infarction 3 flow was achieved and still present at 2-month follow-up. The patient was prescribed aspirin and clopidogrel as a life-long therapy.

We report a case of an eight-year-old boy with Kawasaki disease (KD) who had a giant aneurysm with stenotic lesions located in the right coronary artery, and was treated by transcatheter implantation of a polytetrafluoroethylene(PTFE)-covered stent. Follow-up coronary angiography showed good coronary blood flow. To the best of our knowledge, this is the first child with KD who underwent covered-stent implantation in a coronary aneurysm. Although close follow-up is mandatory, because the long-term outcome is unclear, implantation of a covered stent in a giant aneurysm appears to be a promising treatment option., (Copyright 2006 Wiley-Liss, Inc.)

Recurrence of spontaneous coronary artery dissection is a rare event with limited documentation of its existence in the world's literature. We present a case of recurrent spontaneous coronary artery dissection treated with coronary artery bypass surgery and discuss the literature regarding this entity., (Copyright (c) 2005 Wiley-Liss, Inc.)

Diagnostic angiography is a routine diagnostic procedure in modern day cardiological practice. However, there are potential life threatening complications which can occasionally occur. We describe one such complication and detail the management and clinical outcome., (Copyright 2003 Wiley-Liss, Inc.)

In this case report, we present the first clinical application of a new stent design for autologous venous graft-covered stent preparation. This stent consists of a main body, resembling the configuration of conventional stents, and two connecting arms at the edges of the stent for the stabilization of the venous graft on the external surface of the stent. This new stent design was applied in a patient with an aneurysm in a stented segment in the right coronary artery. The immediate and long-term angiographic evaluation after the covered stent implantation showed complete sealing of the aneurysm without restenosis., (Copyright 2002 Wiley-Liss, Inc.)

Spontaneous coronary dissection is a rare event occurring particularly in women during the peripartum and postpartum period. Two cases related to the early postpartum period with a successful outcome are described, together with a comprehensive review of all the previously published cases. Diagnostic and therapeutic considerations of this unique clinical entity are discussed and reviewed.

Hyperhomocysteinemia is associated with accelerated atherosclerosis, which leads to an increased incidence of premature vascular disease. Although multiple vascular aneurysms have been linked to hyperhomocysteinemia, coronary artery aneurysms have not. We report a case of giant coronary artery aneurysm associated with multiple peripheral vascular aneurysms in a patient with hyperhomocysteinemia.

We describe the implantation of a stent graft to seal off the left main coronary artery aneurysm of a 64-year-old man with guidance by intravascular ultrasound. The aneurysm was successfully sealed off. At 6-month and 1-year follow-up, a small residual aneurysm reappeared, which was treated conservatively. The technical issues in closing this aneurysm and the management of the residual aneurysm are discussed.

Spontaneous coronary artery dissections are relatively uncommon. Many of the previously reported cases have involved a dissection in a single coronary artery of a peripartum or postpartum female. We describe an unusual case of multiple spontaneous coronary dissections in a middle-aged male.

We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999., (Copyright 1999 Wiley-Liss, Inc.)