Unusual and Unexpected Complications of Atherosclerotic Coronary Artery Aneurysms

Abstract

A series of four patients with coronary aneurysms who were thought to have benign coronary ectasia in last decade but had acute coronary syndrome in last two years are presented First patient had triple vessel coronary ectasia and myocardial infarction (MI) 10 years back and had bare metal stent to aneurysmal left circumflex artery. He represented with inferior MI. Repeat angiogram showed triple vessel disease with thrombotic sub-total occlusion of aneurysmal right coronary artery (RCA) and was managed by urgent coronary artery bypass surgery(CABG). Second patient presented with inferior MI on multiple occasions requiring percutaneous interventions (PCI) with thrombosuction. On third occasion, he had PCI and bare metal stent to distal RCA. Subsequently he is doing well on oral anticoagulation and aspirin. Third subject had PCI to RCA, a decade earlier following inferior MI with concurrent aneurysm of circumflex artery. He represented with large NSTEMI with ongoing chest pain. Repeat angiogram showed thrombotic occlusion of aneurysmal segment and was managed with covered stent to aneurysmal segment with good result. The last patient presented with inferior MI and had drug eluting stent to proximal aneurysmal RCA. He represented with inferior MI. Repeat angiogram and OCT both showed large protruding thrombus into the stented aneurysmal segment and was excluded by covered stent along with anticoagulation and aspirin. In summary, coronary aneurysms are rare compared to stenotic CAD. Once thought to be benign are more sinister. Judicious use of PCI, CABG and combination of anticoagulation and antiplatelet are currently the mainstay of therapy.