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A 66 year old man with two previous coronary bypass surgeries underwent coronary angiography and grafts restudy for recurrent angina. A vein graft to the left anterior descending artery (LAD) had a severe stenosis before its insertion with an aneurysmal dilatation of the LAD at the site of the graft insertion (top right). With the help of an interventional radiologist, we proceeded to percutaneous embolisation of the aneurysm using metal wires, which are usually used for cerebral aneurysms, under fluoroscopy. The aneurysm was obliterated completely using 30 wires. Angioplasty with stent insertion was then carried out at the graft stenosis with an excellent result (bottom right). Repeat angiography six weeks later showed no flow in the aneurysm and no restenosis.
The incidence of coronary artery aneurysms ranges from 0.2–4.9% with atherosclerosis as the most common cause in adults. The natural history and prognostic significance of coronary artery aneurysms are not clear. Percutaneous treatment of aneurysms has been reported using coated stents and stents covered with autologous vein graft. However, percutaneous closure using the embolisation technique with thin cerebral metal coils has not been reported previously, and their use could be an alternative treatment option.
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