Cotter Ryan, Krantz Mori, Hogan Shea, Holland Matthew
Division of Cardiology, School of Medicine, University of Colorado, Aurora, CO, USA.
Division of Cardiology, Denver Health Medical Center, Denver CO, USA.
Clin Med Insights Case Rep. 2019 Feb 7;12:1179547619828689. doi: 10.1177/1179547619828689. eCollection 2019.
Coronary artery aneurysms (CAA) are a rare cause of acute coronary syndrome and there is little consensus as to the optimal treatment. Based on case series as well as expert opinion, surgery has been suggested as the optimal treatment for a giant CAA. Here, we present the case of a patient with recurrent myocardial infarction and severe angina due to a giant CAA, who was deemed a poor surgical candidate due to his multiple medical comorbidities. Given his intractable anginal symptoms despite medical therapy, he chose to pursue percutaneous intervention. However, the aneurysm was larger than available covered coronary stents and the patient had significant atherosclerotic disease proximal and distal to the aneurysm itself. Our approach used a long drug-eluting stent as a scaffold to overlap covered coronary stents to successfully exclude the aneurysm. The patient's angina resolved and had no complications or readmissions after nearly 1 year of follow-up.
冠状动脉瘤（CAA）是急性冠状动脉综合征的罕见病因，对于最佳治疗方法几乎没有共识。基于病例系列以及专家意见，手术已被建议作为巨大冠状动脉瘤的最佳治疗方法。在此，我们报告一例因巨大冠状动脉瘤导致反复心肌梗死和严重心绞痛的患者，由于其多种内科合并症，被认为是手术的不良候选者。尽管进行了药物治疗，但鉴于他难以控制的心绞痛症状，他选择接受经皮介入治疗。然而，动脉瘤大于可用的覆膜冠状动脉支架，并且患者在动脉瘤本身的近端和远端有明显的动脉粥样硬化疾病。我们的方法是使用长的药物洗脱支架作为支架，与覆膜冠状动脉支架重叠，以成功排除动脉瘤。患者的心绞痛得到缓解，经过近1年的随访，没有出现并发症或再次入院情况。
