IVUS-Guided Exclusion of Right Coronary Artery Aneurysm in Multivessel Coronary Artery Disease Using Hybrid Stenting.

BACKGROUND: Optimal management of coronary aneurysms remains controversial, especially in multivessel disease, where surgical revascularization is often considered. CASE SUMMARY: A 65-year-old man with prior percutaneous coronary intervention of the left anterior descending artery (LAD) presented with worsening exertional angina. Angiography demonstrated severe mid-LAD stenosis proximal to a previously implanted stent and a large saccular aneurysm (8.55 × 7.88 mm) in the proximal right coronary artery with significant distal stenosis. Coronary artery bypass grafting was recommended; however, the patient declined surgery. Percutaneous coronary intervention of the mid-LAD was performed followed by a hybrid percutaneous approach for right coronary artery aneurysm exclusion, with initial drug-eluting stent implantation and subsequent covered stent deployment under intravascular ultrasound (IVUS) guidance. DISCUSSION: This case highlights the role of IVUS and technical challenges in effective coronary aneurysm exclusion via hybrid stenting technique. TAKE HOME MESSAGE: IVUS-guided hybrid stenting may represent a feasible percutaneous treatment strategy for selected coronary artery aneurysms.