A new device to seal large coronary aneurysms: a case report

Abstract

Introduction: Coronary artery aneurysm is an uncommon disease. It is defined as a coronary artery dilatation, exceeding the diameter of the normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Coronary artery aneurysms are typically diagnosed by coronary angiography. The prognosis of coronary artery aneurysm is not well known and the management is challenging.

Case presentation: A 68-year-old Italian-Caucasian man presented to our hospital with angina. Coronary angiography revealed a large coronary aneurysm of the right coronary artery, which was successfully treated by the percutaneous implantation of an MGuardTM stent.

Conclusion: This case report provides evidence that coronary artery aneurysms, even if very large, can be safely treated by MGuardTM stent implantation. We strongly emphasize the high flexibility and good deliverability of this device, which leads to the complete exclusion of the aneurysm mediated by the process of endothelization of its thin mesh sleeves.

Figure 1

Coronary angiography and CT scan before and after MGuard stent implantaion. (A) The unexpanded (top) and the expanded stent covered with a sleeve mesh (bottom). Reproduced with permission from InspireMD. (B) Angiography of the right coronary artery with the presence of a large saccular aneurysm involving the distal part of the artery to the crux cordis. (C) Partial opacification of the aneurysmal sac through the holes of the mesh just after stent implantation. (D) Coronary angiography at one month follow-up showing the exclusion of the aneurysm. (E) Coronary CT scan at one month: multiplanar reformation of the right coronary artery near the crux cordis; on the right ventricle side of the distal part of the stent, is clearly demonstrated the water density remnant of the treated aneurysm (arrows): low density fat is surrounding the proximal stent. (F) Coronary CT scan at one month: The magnified view of the stent allows for a better identification of the treated aneurysm (arrows).