Diagnosis and Management of a Large RCA Aneurysm Treated With IVUS-Guided PCI Using Covered Stents

Abstract

Background An 82-year-old man received a diagnosis of a large right coronary artery (RCA) aneurysm after subsequent visualization of an epicardial mass at the inferior aspect of the right ventricle on a chest CT scan. Case Summary Our patient presented with an extensive vascular history with a growing RCA aneurysm. Intravascular ultrasonography (IVUS)–guided percutaneous coronary intervention isolated the aneurysm, and 2 overlapping covered stents were successfully deployed, thereby restoring distal RCA perfusion. Discussion RCA aneurysms are rare, and our patient was considered to be at high risk, which eliminated the possibility of surgical intervention. He ultimately underwent successful IVUS-guided percutaneous exclusion of the aneurysm by the placement of 2 overlapping covered stents. Take-Home Messages IVUS is essential for coronary aneurysm intervention, particularly when standard angiography is insufficient because of the aneurysm size. This case illustrates the necessity of IVUS-guided imaging in place of traditional percutaneous coronary intervention for the management of coronary aneurysms.