Stent-Associated Coronary Artery Aneurysm Treated With Interposition Graft and Branch Reimplantation.

BACKGROUND: Coronary artery aneurysms have an incidence of 0.3% to 5.3% following percutaneous transluminal coronary angioplasty. CASE SUMMARY: A 75-year-old woman presented with dyspnea on exertion and chest discomfort. In 2004 she underwent percutaneous coronary intervention to the left anterior descending artery (LAD) and, in 2010, a ST-segment elevation myocardial infarction was treated with another LAD stent. On this admission, catheterization revealed a large proximal LAD coronary aneurysm at the site where the last stent was placed. She underwent successful LAD aneurysm repair with end-to-end saphenous vein graft interposition and end-to-side bypass to the diagonal branches. DISCUSSION: The most common surgical procedures are ligation and coronary artery bypass graft. In our case, the diagonal branches were too small to perform epicardial bypasses. TAKE-HOME MESSAGES: Repair of coronary aneurysm with interposition of saphenous vein graft re-establishes flow to the main vessel and tributaries. Adequate exposure and meticulous techniques are essential for success.