Stent-Assisted Coil Embolization of a Large Fusiform Aneurysm of Proximal Anterior Descending Artery

A 37-year-old Asian American man presented with severe stable angina of recent onset over a period of 3 weeks. He was an active policeman, whose only significant past medical history was a prolonged febrile illness with a rash at age 5. Exercise myocardial perfusion stress test was strongly positive with ST depression in inferolateral leads and large reversible perfusion defects in the inferior, inferolateral, and lateral walls of the left ventricle. Cardiac catheterization revealed a large fusiform aneurysm of the proximal left anterior descending (LAD) artery, ectasia of the proximal circumflex artery with 95% narrowing, and an occluded right coronary artery with an occluded proximal aneurysm. (Figure 1).Figure 1. Coronary angiogram showing a proximal aneurysm of the left anterior descending (LAD) artery and ecstatic circumflex artery with severe stenosis inside the ecstatic segment.Coronary CT angiogram showed 3-dimensional extent of the aneurysms, stenoses, and, in particular, the LAD aneurysm's relation to the main pulmonary artery. The LAD aneurysm measured 11.7×17.7×24.2 mm, with a 2.5-mm diagonal artery arising from the side wall. (Figure 2).Figure 2. A, Computed tomography (CT) angiogram showing aneurysms and stenoses. B, CT angiogram showing …