Giant Saccular Aneurysm of the Right Coronary Artery

J INVASIVE CARDIOL 2021;33(10):E833.

Key words: coronary artery aneurysm, left main coronary artery stenosis, aneurysm ligation

A 50-year-old man was admitted to the emergency room with unstable angina pectoris. The patient had no medical history except hypertension. On physical examination, blood pressure was 140/90 mm Hg, heart was in sinus rhythm, and rate was 80 beats/min. The patient was taken to the coronary intensive care unit with the diagnosis of non-ST segment elevation acute coronary syndrome due to negative T waves in the inferolateral leads on electrocardiographic examination. The patient was taken to the catheterization laboratory for primary percutaneous coronary intervention, as chest pain persisted despite vasodilator therapy. Coronary angiography revealed a 70% stenosis distal to the left main coronary artery, including the ostias of the left anterior descending (LAD) coronary artery and circumflex (CX) artery (Figure 1A). The distal LAD was completely occluded and 80% stenosis was found in the mid segment of the CX-first obtuse marginal artery. In addition, a large, saccular-type coronary aneurysm (15 x 15 mm) was detected in the mid segment of the right coronary artery (RCA) and a 90% stenosis was detected before this aneurysmatic segment (Figure 1B and Figure 1C; Video 1). Emergency coronary artery bypass graft surgery was performed on the patient, whose chest pain continued, and 3 vessels were grafted. During surgery, ligation was performed primarily to the RCA aneurysm (Figure 1D). No signs of systemic disease were observed in the patient’s postoperative rheumatological examinations and tests. The patient did not have any problems during the follow-up and was discharged.

Coronary artery aneurysm (CAA) is defined as a segmental coronary dilation that exceeds the diameter of the adjacent normal coronary artery 1.5 times.¹ Its incidence in the general population is between 1.5% and 5%.² However, CAAs >10 mm are extremely rare. Causes of CAA include atherosclerosis, Kawasaki disease, percutaneous transluminal coronary angioplasty complications, and rheumatological diseases, such as Behçet's disease.^3,4 Treatment options include medical therapy, endovascular procedures, and open surgical techniques. Postoperative rheumatological examination findings and tests were completely normal. The cause of CAA in this patient with diffuse coronary artery disease was evaluated as atherosclerosis. The CAA lesion was not the cause of acute coronary syndrome in our patient. Therefore, CAAs can remain asymptomatic for many years. Individuals with systemic diseases, such as Kawasaki and Behçet’s disease, should be monitored for CAAs.