Coronary stent fracture complicated by saccular coronary aneurysm successfully treated with a covered stent: a case report.

BACKGROUND: Coronary stent fracture is an uncommon mechanical complication of percutaneous coronary intervention (PCI) that may lead to adverse outcomes such as in-stent restenosis, thrombosis, and, rarely, coronary artery aneurysm (CAA) formation. The coexistence of stent fracture and a saccular coronary aneurysm represents a particularly high-risk scenario requiring careful diagnostic assessment and individualized management. CASE SUMMARY: A 65-year-old man with long-standing hypertension and type 2 diabetes mellitus presented with recurrent rest angina and evidence of inducible myocardial ischaemia. Coronary angiography revealed multivessel coronary artery disease, and the patient underwent staged PCI with rotational atherectomy and implantation of overlapping drug-eluting stents in the left anterior descending artery. Follow-up imaging identified an abnormal contrast-filled structure adjacent to the proximal stent, initially suspected to represent plaque extrusion or aneurysm formation. Optical coherence tomography (OCT) later demonstrated a type IB stent fracture associated with a saccular CAA measuring ∼5 mm in diameter and 10 mm in length. The lesion was successfully treated with implantation of a covered coronary stent under OCT guidance, achieving complete aneurysm exclusion and restoration of normal coronary flow. DISCUSSION: Stent fracture complicated by CAA is a rare but clinically relevant complication of PCI. High-resolution intracoronary imaging plays a crucial role in establishing the diagnosis, characterizing aneurysm morphology, and guiding treatment. In selected cases, OCT-guided implantation of a covered stent offers an effective percutaneous strategy for aneurysm exclusion while preserving vessel patency.