1. Management of a single coronary artery aneurysm by use of a covered stent
Adel Gamal, MD and Mohamed Saber, Msc
Department of Cardiology, Ain Sham University Hospitals, Egypt

2. HISTORY 68 year old male patient
Presented with typical angina pain for 2 weeks.
Previously underwent PCI to LAD, LCX and RCA by four DES six years ago. He also had a small aneurysm in the proximal LAD which was left for medical treatment.
Stress echocardiogram reproduced his chest discomfort and demonstrated 2 mm of ST depression and anteroapical hypokinesis.

3. Coronary angiography demonstrated a 25-mm aneurysm of the proximal left anterior descending artery (LAD) with patent previously deployed stents and no significant stenosis as shown in videos 1 and 2.

4. VIDEO 1 – The LAD aneurysm in RAO caudal view

5. VIDEO 2 – The LAD aneurysm in PA Cranial view

6. Indications of intervention in coronary artery aneurysms (CAAs)
Symptomatic patients with:
CAAs near bifurcation of large branches;
Evidence of emboli from the aneurysm to the distal coronary bed resulting in myocardial ischemia;
Progressive enlargement of a CAA documented by serial angiographic measurements; and
CAAs in the left main stem.
Repair is considered mandatory for coronary aneurysms that are 3 times larger than the original vessel diameter.
J Invasive Cardiol. 2012;24(9):

7. So intervention was planned to exclude the aneurysm.
An 6F Cordis JL 4 coronary guide was used to cannulate the left coronary system, and a 0.014" BMW wire was used to wire the LAD. A 3.5 × 26-mm -Jostent coronary stent graft was positioned across the aneurysm as shown in videos 3 and 4.

8. VIDEO 3 – Crossing the wire

9. VIDEO 4 – Positioning of the covered stent

10. The stent was inflated at 20 atm for proper expansion and to reduce the risk of in- stent restenosis.
Complete angiographic exclusion of the LAD aneurysm was achieved without affection of any of the LAD branches.

11. In order to reduce the risk of in – stent restenosis, which is highest at the edges of the covered stent, two Xience stents (3.5x12mm and 3.5x15mm) were deployed at the proximal and distal edges of the covered stent respectively as shown in the following vidoes.

12. VIDEO 5- Proximal stent

13. VIDEO 6 – Distal stent

14. VIDEO 7 – Final result

15. The patient was discharged home the next day on his regular daily medications including aspirin 325 mg and Clopidogrel 150mg for the first two weeks then 75mg daily.
One month later, the stress echocardiogram was repeated and was completely normal.

16. THANK YOU