Coronary artery aneurysm (CAA) is an uncommon finding, and optimal percutaneous coronary intervention (PCI) strategies for acute coronary syndrome (ACS) associated with CAA have yet to be established.Case presentation: A 66-year-old man presented with chest pain, dynamic ST-segment depression, and elevated troponin T levels, consistent with non-ST-segment elevation myocardial infarction.Coronary angiography revealed an aneurysm in the proximal left anterior descending artery with severe adjacent stenosis.Initial balloon angioplasty restored normal coronary flow and relieved symptoms.Cardiac computed tomography demonstrated a large aneurysm (15 × 18 mm), exceeding the size estimated by angiography.Based on detailed anatomical assessment, staged PCI was performed.Under intravascular ultrasound guidance, a 3.5-mm drug-eluting stent was deployed across the aneurysm neck, followed by coil embolization via a jailed microcatheter to achieve aneurysm exclusion.Final angiography and intravascular ultrasound confirmed complete exclusion of the aneurysm without coil protrusion.At 1-year follow-up, imaging demonstrated persistent exclusion without in-stent restenosis, and the patient remained asymptomatic.In ACS complicated by CAA, a staged strategy consisting of initial flow restoration followed by multimodality imaging-guided stent-assisted coil embolization may enable safe and durable aneurysm exclusion.Preprocedural computed tomography and intraprocedural intravascular ultrasound are essential for accurate anatomical assessment and procedural optimization.
Mogi et al. (Thu,) studied this question.