https://orcid.org/0000-0002-9647-3077
A 70-year-old woman previously underwent placement of two stents (a bare metal stent and drug-eluting stent) to the same site in the right coronary artery (RCA) for repeated myocardial infarctions. The coronary CT (Panel A) at that time revealed a giant coronary artery aneurysm (CAA) at the occlusion site in the RCA. However, she again developed a ST elevation myocardial infarction (TEMI) of the RCA due to a stent occlusion. Before emergency coronary angiography, coronary CT revealed a growing RCA aneurysm and slight pericardial effusion (Panel B), suggestive of an impending rupture. Therefore, an urgent surgical bypass procedure with the saphenous vein to the RCA and a CAA excision were performed (Panel C). The gross pathology of the coronary aneurysm revealed a true aneurysm with abundant thrombi, calcifications, and massive atheroma (Panel D). She currently returns for follow-up visits. A CAA is a relatively uncommon disorder but is an important consideration in the differential diagnosis. Clinical symptoms vary from incidental findings to acute coronary syndromes. Mechanisms of CAAs involve genetic susceptibility, mechanical vessel wall injury, autoimmune disease, and infections. The phenotypes include saccular, fusiform, and ectasia, which appear as thromboses, ruptures, and external compression. Treatment options for CAAs are oral medications (anticoagulants, dual antiplatelet agents, and single agents), covered stents, coil embolization, and surgical treatment. However, no definitive treatment has yet been determined. The important point is that imaging during a relatively short follow-up period for CAAs should be considered, and early therapeutic intervention is necessary in such cases as growing CAAs.
The authors thank Professor Hiroyuki Hao (Department of Pathology, Nihon University Itabashi Hospital) and Dr Yutaka Koyama (Department of Pathology, Nihon university Itabashi Hospital) for contributing to the discussion on the pathology. We would also like to thank Professor Masashi Tanaka (Department of Cardiovascular surgery, Nihon University Itabashi Hospital) for performing the surgery and Professor Masahiro Okada (Department of Radiology, Nihon University Itabashi Hospital) for constructing the images.
The data underlying this article will be shared on reasonable request to the corresponding author.
Author notes
Conflict of interest: None declared.
