ArticleJournal of visualized surgery2024
Surgical coronary angioplasty with common femoral artery and coronary artery bypass grafting for the treatment of left main coronary artery aneurysm outside the stent: a case report.
Article in Journal of visualized surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Managing coronary artery aneurysms (CAAs), especially those outside stents, is a considerable clinical challenge. The optimal material for coronary artery patch plasty is not well-established. This report illustrates a novel approach using the common femoral artery (CFA) for coronary patch plasty and concurrent coronary artery bypass grafting (CABG) in the case of a symptomatic CAA in the left main coronary artery (LMCA) outside the stent. Case Description: A 51-year-old male initially presented with exertional angina. Imaging revealed a giant ulcerated aneurysm in the LMCA and total occlusion at the ostium of the proximal left anterior descending artery (LAD). He underwent percutaneous coronary intervention (PCI) that included directional coronary atherectomy (DCA) of the proximal LAD and stenting from LMCA to mid-LAD. This procedure alleviated his symptoms. The patient was put on dual antiplatelet therapy (DAPT) and statin but ceased follow-up and medication one-year post-PCI. Three years post-PCI, the patient returned with exertional chest discomfort and dyspnea. Further imaging showed the enlargement of the known LMCA ulcer/aneurysm outside the stent but no new stenotic lesion in the stent or the native coronary arteries. The heart team decided on surgical intervention. The patient underwent coronary patch plasty with a CFA and CABG, utilizing left internal thoracic artery (LITA)-LAD and aorto-saphenous vein graft (Ao-SVG)-left circumflex artery (LCX). Conclusions: This case suggests surgical coronary angioplasty using a CFA, along with CABG, can be a promising treatment option for managing symptomatic LMCA aneurysms located outside stents. However, further studies are needed to verify the safety and efficacy of this approach in a larger patient population.
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