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Abstract 428: A Localized Giant Coronary Artery Aneurysm


 Background:
 Coronary artery aneurysm (CAA) incidence is thought to be as common as 0.3 to 5 % of the angiographically examined patients. Regardless of underlying pathogenic mechanism, it results in adverse long-term outcomes. The management of the CAA can be challenging because of lack of clearly defined guidelines.
 
 
 Case Presentation:
 A 75-year-old male without known history of tobacco abuse, DM, hypertension, OSA, CAD, PCI or connective tissue disorder presented with a chief complaint of 2 months of intermittent angina. He had an unremarkable serum troponin level and an EKG. Echocardiogram revealed moderate mitral regurgitation without any regional wall motion abnormality [1]. Because of equivocal exercise stress EKG test, he underwent a coronary angiogram which showed a proximal LAD stenosis followed by a localized fusiform aneurysm [2]. Given his significant symptoms, large size of the aneurysm, ostial LAD stenosis and proximity of diagonal arterial branch the patient underwent CABG surgery involving LIMA to LAD.
 
 
 Discussion:
 CAA patients may present with stable angina, ACS or it may just be an incidental finding on a coronary angiogram. The pathogenesis of CAA is not well known. However, some of the risk factors can be genetic predisposition, underlying atherosclerotic coronary artery disease, autoimmune and connective tissue disorders, trauma such as following PCI, and infections. Coronary CT can be of great utility in evaluating giant CAA as it can help to delineate mechanical complications of these aneurysms. In our patient it was unusual to see localized CAD and an aneurysm limited to one coronary artery territory when atherosclerotic CAAs usually affect more than one artery.
 
 
 Conclusion:
 Since pathophysiology of CAA is not well understood and there are no obvious society guidelines regarding their management, therefore, it becomes important to tailor treatment based on the location and size of the CAA, underlying risk factors and the clinical presentation.
 
 
 
