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Coronary artery aneurysms are rare disorders defined by a vessel diameter > 1.5 times the reference artery. Aneurysms can be characterised by abnormal dilatation of a localised or diffuse arterial segment. Potential complications associated with these abnormalities include thrombus formation and distal embolisation and, rarely, rupture. Until recently, the only alternative to medical treatment was surgical ligation of the aneurysm with distal bypass surgery. We report on the effectiveness of polytetrafluoroethylene (PTFE) covered stents in the treatment of two separate patients. In both cases the aneurysms were most likely caused by coronary artery atherosclerosis.
(A) 71 year old male, admitted for angina at rest. History of previous non-Q wave myocardial infarction. Coronary angiography showed a thrombus containing giant aneurysm of the left circumflex coronary artery as well as a > 75% stenosis distal to the aneurysm. (B) Two PTFE covered stents (4.0 × 19 mm + 4.0 × 16 mm, GraftMaster Jostent, Jomed) were necessary to cover this large fusiform aneurysm completely. High pressure balloon post-dilatation was performed with final TIMI 3 grade flow. The patient was pre-treated with glycoprotein IIb/IIIa inhibitors. Upon discharge, clopidogrel and aspirin treatment was started. The patient was well at three months follow up.
(A) 77 year old male, admitted for unstable angina. Coronary angiography revealed triple vessel coronary artery disease and a large saccular aneurysm of the proximal left anterior descending coronary artery. A 75% stenosis was present in the artery immediately proximal to the aneurysm. (B) Both stenosis and aneurysm were treated with a PTFE covered stent (3.0 × 16 mm, GraftMaster Jostent, Jomed). The covered stent completely closed the entrance of the aneurysm, and no contrast medium was seen entering the aneurysm in the final angiographic images. The first diagonal branch was occluded, causing a lateral myocardial infarction with creatine phosphokinase peak of 891 IU/l. The patient was discharged after six days, and treatment with aspirin and clopidogrel was begun.