Ahmet KIVRAK, Ahmet Hakan ATEŞ, Ergun Barış KAYA, Mehmet Levent ŞAHİNER, Kudret AYTEMİR
The Anatolian Journal of Cardiology - 2026;30(6):0-0
Coronary artery aneurysms are uncommon and may be particularly difficult to treat when they coexist with significant stenosis and branch vessel involvement. We present a 67-year-old man with stable angina and no previous coronary imaging. Coronary computed tomography angiography demonstrated 2 adjacent aneurysms in the proximal left anterior descending artery (LAD): a fusiform aneurysm followed by a larger saccular aneurysm. Coronary angiography confirmed sequential dual LAD aneurysms with preserved distal flow, while the first and second diagonal branches arose from the distal margin of the saccular aneurysm. Intravascular ultrasound clarified aneurysm morphology, branch relationship, and landing zones, and also showed significant plaque burden distal to the aneurysmal segment. Because complete exclusion with a covered stent alone would risk compromising diagonal branch flow, a stepwise hybrid percutaneous strategy was chosen. After balloon interrogation of the aneurysm-diagonal branch relationship, a drug-eluting stent was implanted from the distal half of the second aneurysm to the distal LAD to treat the stenotic segment while preserving side branch patency. Two overlapping covered stents were then deployed proximally. Persistent filling of the distal aneurysm was subsequently treated by coil embolization through the stent struts with a microcatheter. Final angiography demonstrated complete exclusion of the aneurysms with preserved diagonal branch flow and TIMI 3 distal flow. This case highlights that individualized hybrid treatment combining covered stents and coil embolization may be an effective option in selected complex coronary aneurysms with bifurcation anatomy.
