Cover Image: Symptomatic left main coronary artery aneurysm: interest of multi-slice computed tomography for diagnosis and follow-up
Meyer Elbaz, Eric Maupas, and Didier Carrié
Department of Cardiology, Rangueil Hospital, Toulouse, France
A 59-year-old man without medical history and only current smoking as a cardiovascular risk factor had new onset of angina with exertional chest pain. Rest ECG was considered as normal. The treadmill test reproduced chest pain with ST depression from V1 to V6.
Coronary angiogram revealed an isolated saccular aneurysm of the left main coronary artery (Panel A). Intravascular imaging performed at the same time confirmed the diagnosis of true aneurysm (maximum lumen area 50% larger than proximal reference) without atherosclerotic plaque. A 16-slice ECG-gated multi-slice computed tomography (MSCT) was performed before any treatment decision (Panel C). Cutaneous biopsy and exhaustive biological explorations (viral and syphilis serologies, inflammatory and metabolic markers) were performed and were negative. Therefore the patient underwent successful stent implantation with initial angiographic persistence of the aneurysm. MSCT control performed 48 h later revealed complete exclusion of the aneurysm probably due to thrombosis occlusion (Panel D). The patient was discharged 2 days later on aspirin (75 mg daily) and clopidogrel (75 mg daily).
Exertional chest pain disappeared with normalization of the treadmill test. Six-month MSCT showed a slight intimal hyperplasia as a good mid-term result of coronary stent placement procedure (Panel E) and was secondarily confirmed by angiography (Panel B).
Figure legend
Coronary angiography showed a giant left main coronary artery aneurysm (Panel A). Intravascular ultrasound confirmed the diagnosis of true aneurysm with a normal appearing three layer aspect (Panel A, arrow). The 6 month angiogram showed a good mid-term result (Panel B). Initial MSCT confirmed the diagnosis of aneurysm (Panels A–C). Two days after stent implantation, the aneurysm disappeared (Panel D). Six-month MSCT showed intra-stent irregularities corresponding to intimal hyperplasia (Panel E).
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