Large coronary aneurysm complicated by acute myocardial infarction: combined intravascular ultrasound imaging and doppler flow assessment before and after PTFE-covered stent implantation.
Although most patients with coronary artery aneurysms are asymptomatic, manifestations of myocardial ischemia may occur. However, the role that a coronary aneurysm may play in impairing arterial flow of an otherwise normal coronary circulation is not completely known. A 64-year-old woman with previous anteroseptal myocardial infarction was found to have a large aneurysm of the proximal left anterior descending (LAD) coronary artery without angiographic evidence of atherosclerotic disease. IVUS evaluation revealed an 18 mm long and 12.2 x 10.8 mm wide aneurysm without atherosclerosis, thrombus or calcification. Pulsed wave Doppler showed significant reduction of LAD flow reserve, which normalized after successful obliteration of the aneurysm with polytetrafluoroethylene (PTFE)-covered stent implantation. Severe in-stent graft restenosis was found at 7-month angiographic and intravascular ultrasound follow-up, which was managed successfully with minimally invasive direct coronary bypass surgery. The patient did well, without symptoms over the following year.
Bartorelli
Antonio L
AL
Institute of Cardiology, University of Milan, Centro Cardiologico Monzino IRCSS, Italy. albartorelli@cardiologicomonzino.it
Grancini
Luca
L
Montorsi
Piero
P
Trabattoni
Daniela
D
Fabbiocchi
Franco
F
D019917:Blood Vessel Prosthesis Implantation; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D003323:Coronary Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene