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Case Reports
. 2015 Aug 1;42(4):397-9.
doi: 10.14503/THIJ-13-4020. eCollection 2015 Aug.

Percutaneous Management of a Coronary Bifurcation Aneurysm with Mesh-Covered Stents and the Simultaneous Kissing Stent Technique

Gabriele Crimi, Davide Bartolini, Sandro Bellotti, Alessandro Iannone, Paolo Rubartelli
Case Reports

Percutaneous Management of a Coronary Bifurcation Aneurysm with Mesh-Covered Stents and the Simultaneous Kissing Stent Technique

Gabriele Crimi et al. Tex Heart Inst J. .

Abstract

A 63-year-old man was admitted with a clinical diagnosis of acute coronary syndrome (non-ST-segment elevation), characterized by regional hypokinesia of the left ventricular posterior and lateral walls and by positive cardiac biomarkers. The coronary angiogram showed a 12.5-mm-diameter aneurysm with a mural thrombus and possible distal embolism to the bifurcation of the left circumflex coronary artery and the 2nd marginal branch. The aneurysm was managed percutaneously by implanting 2 mesh-covered stents in accordance with the "simultaneous kissing stent" technique. Follow-up angiography and optical coherence tomography at 5 postprocedural months documented complete sealing of the aneurysm and diffuse in-stent restenosis. No sign of ischemia occurred during the subsequent follow-up.

Keywords: Acute coronary syndrome; bifurcation aneurysm; blood vessel prosthesis implantation; coronary aneurysm/diagnosis/therapy; disease progression; percutaneous coronary intervention/methods; stents.

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Figures

Fig. 1.
Fig. 1.
Coronary angiogram (anteroposterior 40° caudal view) of the left coronary artery shows a large coronary aneurysm involving the bifurcation of a dominant left circumflex coronary artery. A hazy lesion of moderate size is visible in the proximal marginal branch (arrow). Supplemental motion image is available for Figure 1.
Fig. 2.
Fig. 2.
Coronary angiogram (anteroposterior 40° caudal view) shows the left coronary artery after mesh-covered stent implantation by means of the simultaneous kissing stent technique. The coronary aneurysm was not acutely sealed; slow flow and incomplete opacification of the cavity are shown.
Fig. 3.
Fig. 3.
After 5 months, coronary angiogram (anteroposterior 40° caudal view) shows tight, diffuse, in-stent restenosis in the left coronary artery.
Fig. 4.
Fig. 4.
Final coronary angiogram (anteroposterior 40° caudal view), after drug-eluting stent implantation, shows that a small marginal bifurcation branch was compromised after stent implantation (arrows). Supplemental motion image is available for Figure 4.
See this image and copyright information in PMC

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