Successful long‐term therapy following saphenous vein‐covered stent deployment for atherosclerotic coronary aneurysm

Abstract

We describe a case of atherosclerotic aneurysm involving the left main coronary artery in a patient with prior coronary artery bypass surgery. A saphenous vein-covered stent was used to seal the aneurysm in conjunction with conventional stenting of an associated native vessel coronary stenosis. Focal late restenosis involving the stent graft was successfully treated with repeat angioplasty and brachytherapy. Autologous vein-covered stent deployment should be considered in the treatment of symptomatic or progressively enlarging coronary aneurysms.

Left main coronary artery aneurysm

“…Successful percutaneous obliteration of a left main coronary artery aneurysm using a covered stent is described [4], with good short-term follow-up. Also, autologous vein-covered stent deployment saphenous vein-covered stent has been used to seal the left main coronary aneurysm [5]. Surgical repair of aneurysm with a pericardial patch or with resection and coronary artery bypass has been recommended as a definitive management [6,7] (Fig.…”

“…Medical treatment consists of antiplatelet agents alone or addition to anticoagulation. Several interventional techniques have been described [4,5]. Successful percutaneous obliteration of a left main coronary artery aneurysm using a covered stent is described [4], with good short-term follow-up.…”

“…Coronary artery aneurysm involving the left main coronary artery is extremely rare [1][2][3][4][5][6][7][8]. Aneurysm commonly involves the right coronary artery, followed by the left anterior descending and the left circumflex coronary arteries [9].…”

Successful sealing of post-interventional coronary aneurysm with coated stent and late recurrence—Follow-up with combined imaging—A case report

“…Successful surgical interventions, e.g., bypass grafting, ligation, and resection, have been reported, but progress in invasive techniques has made stent ''sealing'' possible. PTFE or vein-coated stents deliver promising results [16][17][18][19]. Implantation of a covered stent closures the aneurysmatic sack and allows subsequent thrombosis of the neolumen.…”

A Reappraisal of Saphenous Vein Grafting

“…A modified SV graft (SVG) conduit such as a spiral SVG,3 a cylindrical SVG,45 or vein cuffs and patches,6 sometimes became a necessity for large recipient vessels, or to obtain a potentially good patency. Nowadays, an SVG is the preferable biomaterial in coronary artery bypass, especially for the right coronary system,7 coronary aneurysm or a rupture treated with SVG-covered stents,89 free flap transfer,10 and surgical treatment of Peyronie disease 11. However, the availability of new flexible intravascular stents, allowing access even to tortuous vessels, provides a new therapeutic approach for patients with vascular problems in diverse specialties.…”