Extract

A 74-year-old male presented with ST-elevation myocardial infarction (STEMI). Coronary angiography revealed multiple coronary aneurysms. Coronary computed tomography angiography (CCTA) identified a large mass above the left anterior descending artery (LAD), which exhibited high uptake on fluorodeoxyglucose positron emission tomography. Elevated levels of immunoglobulin G4 (IgG4) were observed, raising suspicion of IgG4-related disease. Corticosteroid therapy was avoided because of concerns about aneurysm wall thinning and rupture.1 Two years later, the patient experienced another STEMI, and a stent was placed from the left main artery to the LAD (Panel A, white dotted line). Final angiography, intravascular ultrasound and CCTA showed a giant aneurysm above the LAD (Panel A, Supplementary data online, Video S1; Panel B, red arrow), prompting catheter-based intervention. The distal part of the previous stent had collapsed into the aneurysm due to vessel wall instability (Panel C, red arrow). A guidewire was advanced through the stent struts. A long drug-eluting stent was first placed across the aneurysm to bridge the prior stent and the LAD (Panel D, red dotted line), followed by the placement of three covered stents within the stent (Panel D, blue oblique line). The final angiogram showed near-complete resolution of aneurysm leakage (panel E, Supplementary data online, Video S2), and CCTA 1 month later revealed the thrombotic transformation of the aneurysm (Panel F, red arrow). This is the first reported case of a giant aneurysm caused by an IgG4-related mass that was successfully treated with covered stents.

You do not currently have access to this article.