Giant coronary artery aneurysm: imaging findings before and after treatment with a polytetrafluoroethylene-covered stent.

Coronary artery aneurysm (CAA), defined as dilatation of the coronary artery exceeding 50% of the reference vessel diameter, is uncommon and occurs in 5% of coronary angiographic series.1 CAAs are termed giant if their diameter exceeds the reference vessel diameter by 4 times or if they are 8 mm in diameter.2 Atherosclerosis accounts for the vast majority of CAAs in adults, whereas Kawasaki disease is responsible for most cases in children.1,2 Up to one third of CAAs are associated with obstructive coronary artery disease and have been associated with myocardial infarction, arrhythmias, or sudden cardiac death.3 A 63-year-old man with typical chest pain and a positive treadmill exercise test was referred for diagnostic coronary angiography. Six years before this hospitalization, the patient had suffered from a subdural hematoma, undergone surgical ligation of a large aneurysm of the left middle cerebral artery in the presence of 2 smaller aneurysms of the right pericallosal artery and internal carotid artery. Oral anticoagulation was initiated after surgery and has been maintained since then. Cardiovascular risk factors consisted of arterial hypertension, diabetes mellitus, dyslipidemia, obesity, a family history for coronary artery disease, and smoking. Coronary angiography showed a focal stenosis of the mid segment of the left anterior descending artery (LAD), followed by a giant coronary aneurysm measuring 16 22 mm (Figure 1A). To alleviate the significant stenosis of the mid-LAD and exclude the giant CAA, percutaneous coronary intervention was planned. Intravascular ultrasound (IVUS) (Atlantis SR 40MHz, iLab, Boston Scientific Inc, Boston, Mass) images were acquired before percutaneous coronary intervention to estimate vessel size and length of the base of the aneurysm (Figure 1B). After IVUS, the proximal stenosis was treated with a 3.0/20-mm balloon (Maverick 2, Boston Scientific Inc) inflated to 10 bars for 12 seconds. Thereafter, the aneurysm was excluded from the native coronary artery by placement of a 3.5/26-mm polytetrafluoroethylene (PTFE)--covered stent (Graft-