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A 61 year old man, post-coronary bypass surgery, was admitted because of exertional angina. Coronary angiography revealed a 60% stenosis in the left main coronary artery, a 90% stenosis in the distal left circumflex coronary artery (LCX), and a giant coronary artery aneurysm just distal to an 80% stenosis in the proximal LCX (left panel). Intravascular ultrasound using motorised pullback demonstrated that the length of the coronary aneurysm was 28 mm. A 26 mm polytetrafluoroethylene (PTFE) covered JoStent (JoMed) premounted on the 3.5 mm balloon catheter was deployed at 18 atm to cover the distal part of the aneurysm (left middle panel). A 16 mm PTFE-covered JoStent premounted on the 3.5 mm balloon catheter was then deployed at 18 atm with 3–4 mm overlap to cover the proximal part of the aneurysm (right middle panel). Postdilatation was performed using a 4.0 mm Maverick balloon catheter (Boston Scientific) inflated to 18 atm. Stenting was then performed in the left main and the distal LCX. The final angiogram showed a good result with complete obliteration of the giant aneurysm (right panel).
The percutaneous treatment of a huge coronary aneurysm using multiple PTFE covered stents appears to be feasible and useful, even though the length of aneurysm exceeds that of the currently available covered stents.