Author + information
- Received January 7, 2013
- Revision received January 23, 2013
- Accepted February 2, 2013
- Published online July 1, 2013.
- Upasana Tayal, BM BCh∗ ( and )
- Ahmed Elghamaz, MB, BCh
- ↵∗Reprint requests and correspondence:
Dr. Upasana Tayal, Northwick Park Hospital, Watford Road, London HA1 3UJ, United Kingdom.
The incidence of coronary aneurysms varies from 1.5% to 5% of cases at angiography (1). The primary complications are ischemia and infarction due to thrombosis or dissection. Spontaneous rupture is rare. The presence of coronary aneurysms, with or without obstructive disease, is an independent risk factor for death (2).
These images are from a 66-year-old man incidentally found to have giant coronary and iliac artery aneurysms. He underwent computed tomography scanning for investigation of renal colic, which revealed a 9.5-cm renal tumor. He did not have angina or claudication.
We were unable to pass any wires into the left anterior descending artery (LAD) for intravascular ultrasound (IVUS) imaging or pressure wire studies. IVUS studies of the circumflex and right coronary arteries are shown (Figs. 1C and 1E).
He underwent stress echocardiography to complete risk stratification before a nephrectomy. Although there was no inducible ischemia, this provided a novel way to visualize the giant LAD aneurysm (Fig. 1D).
He underwent coronary artery bypass graft surgery (CABG) with excision of the LAD aneurysm. He then underwent bilateral aortofemoral bypasses of the iliac artery aneurysms measuring 5.5 × 10 cm and 6.2 × 8 cm.
Risk factors for atherosclerosis should be aggressively managed in these patients. However, optimal treatment strategies, especially in asymptomatic patients, remain unclear. Small uncomplicated aneurysms may be monitored. Larger aneurysms may be treated with percutaneous coronary intervention (PCI), particularly with covered stents, or CABG. Neither modality has proven survival benefits. Lack of commercially available stents to cover giant aneurysms effectively ruled out PCI as a valid option in our case.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 7, 2013.
- Revision received January 23, 2013.
- Accepted February 2, 2013.
- American College of Cardiology Foundation