Cardiology and Cardiovascular Research

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Coronary Artery Pseudoaneurysm with Thrombosis of Distal Left Circumflex Artery: A Case Report

Received: Aug. 19, 2023    Accepted: Sep. 06, 2023    Published: Sep. 18, 2023
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Abstract

Background: Pseudoaneurysm of the coronary artery is a rare condition with an incidence of less than 6%. Only few cases have been reported in the literature. The etiology, treatment options and the use of noninvasive diagnostic tools like Computed tomography need to be discussed for understanding the diagnosis and management of this condition. Case report: We report a rare case of pseudoaneurysm of the left circumflex artery with distal thrombosis following one year after percutaneous coronary intervention in an adult male patient who presented to us as an asymptomatic follow up patient post percutaneous coronary intervention of left circumflex artery for coronary CT angiography. The CT angiogram showed a 2x2 cm pseudoaneurysm with patent proximal stent and distal segment thrombosis with a patent second obtuse marginal artery. We discuss the imaging findings along with the etiology and treatment options of this condition. CONCLUSION: This case highlights the potential risks of coronary stenting especially in complex cases which can result in iatrogenic vessel injury and pseudoaneurysm formation. The case was more challenging as the patient was asymptomatic and there was also distal occlusion of the involved vessel segment. The likely etiology in this case was insertion of prior DES and the treatment options ranged from conservative management with short follow-up, embolization, inserting covered stents and open surgery with aneurysmectomy.

DOI 10.11648/j.ccr.20230703.14
Published in Cardiology and Cardiovascular Research ( Volume 7, Issue 3, September 2023 )
Page(s) 66-69
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Coronary Pseudoaneurysm, Coronary CT Angiography, Coronary Stenting

References
[1] Sahu A, Chandra N. (2020) Intrastent Coronary Pseudoaneurysm in the Setting of Primary Angioplasty: An Early Presentation. Interventional Cardiology. doi: 10.36648/2471-8157.6.1.87.
[2] Slota PA, Fischman DL, Savage MP, Rake R, Goldberg S (1997) Frequency and outcome of development of coronary artery aneurysm after intracoronary stent placement and angioplasty. STRESS Trial Investigators. Am J Cardiol 79: 1104-1106.
[3] Honda TA, Kawano H, Tsuneto A, Nakata T, Yoshida T, Koga S, Ikeda S, Abe K, Hayashi T, Yokose S, Eishi K, Maemura (2020). Coronary Artery Pseudoaneurysm due to Medial Mucoid Degeneration Mimicking an Intra-atrial Mass. Intern Med 54: 2453-2458, DOI: 10.2169/internalmedicine.54.3804.
[4] Amano T, Nakamura S (2018) A case of percutaneous coronary intervention using a polytetrafluoroethylene-covered stent for an iatrogenic pseudoaneurysm of the left main coronary artery. J Cardio Vasc Med 4: 1-5.
[5] Okamura T, Hiro T, Fujii T, Yamada J, Fukumoto Y, Hashimoto G, et al. Late giant coronary aneurysm associated with a fracture of sirolimus eluting stent: a case report. J Cardiol 2008; 51 (1): 74–9.
[6] Aoki J, Kirtane A, Leon Martin B, Dangas G. (2008) Coronary artery aneurysms after drug-eluting stent implantation. JACC CardiovascInterv; 1: 14–21.
[7] Aqel RA, Zoghbi GJ, Iskandrian A. (2004). Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography; 21: 175–182.
[8] Kar S, Webel RR. (2017). Diagnosis and treatment of spontaneous coronary artery pseudoaneurysm: rare anomaly with potentially significant clinical implications. Catheter CardiovascInterv; 90: 589–597.
[9] Stabile E, Escolar E, Weigold G, Weissman NJ, Satler LF, et al. (2004) Marked malapposition and aneurysm for mation after sirolimuseluting coronary stent implantation. Circulation 110: 47-48.
[10] Couto WJ, Livesay JJ, Allam A. Off pump repair of a giant pseudoaneurysm of a distal saphenous vein bypass graft. Ann Thorac Surg 2005; 80: 2376‚ Äì2378.
[11] Indolfi C, Achille F, Tagliamonte G, et al. Polytetrafluorethylene stent deployment for a left anterior descending coronary aneurysm complicated by late acute anterior myocardial infarction. Circulation 2005; 112: e70‚ Äìe71.
[12] Bhupali A, Joshi A, Patil S, Jadhav P, Prasad S, Vora T, Gajiwala N, Thakkar A.(2015) Giant coronary artery pseudoaneurysm after drug-eluting stent implantation. Int J ClinMed; 6: 554–560.
[13] Oyama N, Urasawa K, Kitabatake A. (2004). Detection and treatment of coronary artery pseudoaneurysms following coronary stent deployment. J Invasive Cardiol; 16: 521–523.
[14] Bajaj S, Parikh R, Hamdan A, Bikkina M. (2010) Covered-stent treatment of coronary aneurysm after drug-eluting stent placement. Tex Heart Inst J; 37: 449–454.
[15] Gercken U, Lansky AJ, Buellesfeld L, et al. Results of the Jostent coronary stent graft implantation in various clinical settings: Procedural and follow-up results. Catheter Cardiovasc Interv 2002; 56: 353‚ Äì360.
[16] Briguori C, Sarais C, Sivieri G, et al. Polytetrafluorethylene-covered stent and coronary artery aneurysms. Catheter Cardiovasc Interv 2002; 55: 326‚ Äì330.
[17] Dorros G, Jain A, Kumar K. Management of coronary artery rupture: Covered stent or microcoil embolization. Cathet Cardiovasc Diagn 1995; 36: 148‚ Äì154.
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  • APA Style

    Atul Kapoor, Goldaa Mahajan, Aprajita Kapur. (2023). Coronary Artery Pseudoaneurysm with Thrombosis of Distal Left Circumflex Artery: A Case Report. Cardiology and Cardiovascular Research, 7(3), 66-69. https://doi.org/10.11648/j.ccr.20230703.14

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    ACS Style

    Atul Kapoor; Goldaa Mahajan; Aprajita Kapur. Coronary Artery Pseudoaneurysm with Thrombosis of Distal Left Circumflex Artery: A Case Report. Cardiol. Cardiovasc. Res. 2023, 7(3), 66-69. doi: 10.11648/j.ccr.20230703.14

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    AMA Style

    Atul Kapoor, Goldaa Mahajan, Aprajita Kapur. Coronary Artery Pseudoaneurysm with Thrombosis of Distal Left Circumflex Artery: A Case Report. Cardiol Cardiovasc Res. 2023;7(3):66-69. doi: 10.11648/j.ccr.20230703.14

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  • @article{10.11648/j.ccr.20230703.14,
      author = {Atul Kapoor and Goldaa Mahajan and Aprajita Kapur},
      title = {Coronary Artery Pseudoaneurysm with Thrombosis of Distal Left Circumflex Artery: A Case Report},
      journal = {Cardiology and Cardiovascular Research},
      volume = {7},
      number = {3},
      pages = {66-69},
      doi = {10.11648/j.ccr.20230703.14},
      url = {https://doi.org/10.11648/j.ccr.20230703.14},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ccr.20230703.14},
      abstract = {Background: Pseudoaneurysm of the coronary artery is a rare condition with an incidence of less than 6%. Only few cases have been reported in the literature. The etiology, treatment options and the use of noninvasive diagnostic tools like Computed tomography need to be discussed for understanding the diagnosis and management of this condition. Case report: We report a rare case of pseudoaneurysm of the left circumflex artery with distal thrombosis following one year after percutaneous coronary intervention in an adult male patient who presented to us as an asymptomatic follow up patient post percutaneous coronary intervention of left circumflex artery for coronary CT angiography. The CT angiogram showed a 2x2 cm pseudoaneurysm with patent proximal stent and distal segment thrombosis with a patent second obtuse marginal artery. We discuss the imaging findings along with the etiology and treatment options of this condition. CONCLUSION: This case highlights the potential risks of coronary stenting especially in complex cases which can result in iatrogenic vessel injury and pseudoaneurysm formation. The case was more challenging as the patient was asymptomatic and there was also distal occlusion of the involved vessel segment. The likely etiology in this case was insertion of prior DES and the treatment options ranged from conservative management with short follow-up, embolization, inserting covered stents and open surgery with aneurysmectomy.},
     year = {2023}
    }
    

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    AU  - Atul Kapoor
    AU  - Goldaa Mahajan
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    DO  - 10.11648/j.ccr.20230703.14
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
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    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20230703.14
    AB  - Background: Pseudoaneurysm of the coronary artery is a rare condition with an incidence of less than 6%. Only few cases have been reported in the literature. The etiology, treatment options and the use of noninvasive diagnostic tools like Computed tomography need to be discussed for understanding the diagnosis and management of this condition. Case report: We report a rare case of pseudoaneurysm of the left circumflex artery with distal thrombosis following one year after percutaneous coronary intervention in an adult male patient who presented to us as an asymptomatic follow up patient post percutaneous coronary intervention of left circumflex artery for coronary CT angiography. The CT angiogram showed a 2x2 cm pseudoaneurysm with patent proximal stent and distal segment thrombosis with a patent second obtuse marginal artery. We discuss the imaging findings along with the etiology and treatment options of this condition. CONCLUSION: This case highlights the potential risks of coronary stenting especially in complex cases which can result in iatrogenic vessel injury and pseudoaneurysm formation. The case was more challenging as the patient was asymptomatic and there was also distal occlusion of the involved vessel segment. The likely etiology in this case was insertion of prior DES and the treatment options ranged from conservative management with short follow-up, embolization, inserting covered stents and open surgery with aneurysmectomy.
    VL  - 7
    IS  - 3
    ER  - 

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Author Information
  • Department of Radiodiagnosis, Advanced Diagnostics and Institute of Imaging, Amritsar, India

  • Department of Radiodiagnosis, Advanced Diagnostics and Institute of Imaging, Amritsar, India

  • Department of Radiodiagnosis, Advanced Diagnostics and Institute of Imaging, Amritsar, India

  • Section