SUCCESSFUL USE OF POLYURETHANE COVERED CORONARY STENT (PCCS) FOR MANAGEMENT OF GIANT CORONARY ANEURYSM
Jain A, Aggarwal A, Mehta A, and Qaqi O. SUCCESSFUL USE OF POLYURETHANE COVERED CORONARY STENT (PCCS) FOR MANAGEMENT OF GIANT CORONARY ANEURYSM. Journal of the American College of Cardiology 2021; 77(18):1912.
Journal of the American College of Cardiology
Background: Coronary Artery Aneurysm (CAA) is defined as localized dilatation of coronary artery exceeding 50% of its reference diameter. Although CAA is uncommon, it is associated with a poor prognosis. At present, there are no guidelines on its management. By presenting this case, we acknowledge the scarcity of data on this topic and support the use of PCCS for clinical situations that may mimic our case.
Case: 71 year old female with multiple comorbidities presented with NSTEMI. Coronary angiogram showed 95% stenosis of proximal RCA with a large aneurysm distal to the stenotic segment. Due to multiple comorbidities, patient was deemed a poor surgical candidate. Thereafter, a staged PCI of proximal RCA and simultaneous repair of coronary aneurysm using a single covered coronary stent was planned. A 4mm x 26mm PCCS was deployed successfully. At 6-month follow-up, the patient had no major adverse cardiovascular event.
Decision-making: PCCS were originally approved to treat coronary perforations. Data on its use in treating CAA is not sufficient. Our patient had prohibitive surgical risk. Clinical presentation was complicated with the presence of a large aneurysm in conjunction with significant subtotal stenosis. We decided to intervene percutaneously and fix both lesions simultaneously.
Conclusion: Giant CAA although occurs infrequently, it may have dreaded complications like rupture and death. PCCS could potentially be used to seal-off CAA, if hemodynamically indicated in a poor surgical candidate.