Coil embolisation of a distal branch aneurysm of the right coronary artery with parent-vessel preservation: a case report

Aneurysms of distal coronary branches are difficult to manage. The aneurysm must be excluded without compromising the parent vessel and the myocardium it supplies. Posterolateral branch aneurysms of the right coronary artery are uncommon and no standardised interventional approach has been described. A 62-year-old woman with a three-month history of exertional palpitations and dizziness was found at coronary angiography to have a 7.6 × 6.4 mm saccular aneurysm arising from a posterolateral branch of a dominant right coronary artery. No stenosis of 50% or greater was present. The parent branch measured approximately 2.6 mm and the aneurysm neck 3.2 mm. Serological, microbiological and computed tomographic investigations did not identify a specific aetiology. Surveillance, covered stenting, surgical exclusion and coil embolisation were discussed with the patient, and selective sac embolisation was performed through a 5 F Judkins Right 4 guiding catheter and a 2.2 F microcatheter using four detachable coils. Completion angiography in two projections showed no residual filling with the coil mass confined to the sac, and Thrombolysis in Myocardial Infarction grade 3 flow was preserved in the parent vessel and distal branch. The patient was discharged within 24 h on aspirin and reported resolution of symptoms at two weeks. Longer-term imaging results were not available. Coil embolisation achieved immediate angiographic exclusion of a distal posterolateral branch aneurysm with preservation of the parent vessel and distal flow, whereas symptom causality, durable occlusion and comparative benefit remain unestablished and require longer follow-up. Not applicable.