Extract

Few reports are available regarding the natural history of coronary aneurysms. The consensus is that they may enlarge overtime and eventually rupture. The possibility of a catastrophic evolution supports invasive management, but this is mostly based on autoptical reports.

We present the case of a 56-year-old male, smoker and affected by hypertension. He was admitted for an anterior ST-elevation myocardial infarction (STEMI) in three-vessel disease. Thrombotic occlusion of proximal left anterior descending artery (LAD) was apparent (Supplementary material online, Video S1). Successful percutaneous thrombus aspiration and bare-metal stent (BMS) implantation (3.5 × 23 mm) was performed (Supplementary material online, Video S2). A small residual plus image was visible proximal to the stent edge at the final angiogram (Panel A).

Four months later, the patient underwent a second elective percutaneous coronary intervention with two drug eluting stents (DES) on the right coronary artery (RCA) (Supplementary material online, Video S3–4). The development of an aneurysm was visible in proximal LAD (Panel B, Supplementary material online, Video S5–6). The maximum diameter was 6 mm by quantitative coronary angiography (QCA).

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