1. Call for CASES Leszek D. Stachaczyk, MD Pawel Buszman, MD, FESC, FSCAI American Heart of Poland, Ustroñ, Poland & CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Leszek D. Stachaczyk, MD Pawel Buszman, MD, FESC, FSCAI American Heart of Poland, Ustroñ, Poland & CCU, Upper-Silesian Center of Cardiology, Silesian Medical School, Katowice, Poland Percutaneous closure of coronary artery aneurysm: long term implication Percutaneous closure of coronary artery aneurysm: long term implication

2. Introduction Atherosclerosis of coronary artery may result in lumen narrowing or anurysm formation. Coronary anurysm enhances the risk of local thrombosis and/or peripheral embolisation. There is no established treatment for large coronary aneurysms. Atherosclerosis of coronary artery may result in lumen narrowing or anurysm formation. Coronary anurysm enhances the risk of local thrombosis and/or peripheral embolisation. There is no established treatment for large coronary aneurysms.

3. Age 47 / male Symptoms: Unstable Angina. Medical History: non-Q myocardial infarction in 1994. Risk factors: Hypercholesterolaemia, ex-smoker. Age 47 / male Symptoms: Unstable Angina. Medical History: non-Q myocardial infarction in 1994. Risk factors: Hypercholesterolaemia, ex-smoker. Description of the problem Case report:

4. Description of the problem Concomitant treatment of coronary artery stenosis and aneurysm.Concomitant treatment of coronary artery stenosis and aneurysm. Percutaneous closure of left anterior descending coronary artery aneurysm with stent graft.Percutaneous closure of left anterior descending coronary artery aneurysm with stent graft. Concomitant treatment of coronary artery stenosis and aneurysm.Concomitant treatment of coronary artery stenosis and aneurysm. Percutaneous closure of left anterior descending coronary artery aneurysm with stent graft.Percutaneous closure of left anterior descending coronary artery aneurysm with stent graft.

5. Left anterior descending coronary artery aneurysm. LCA: RAO 30 Coronary angiography: LCA: LM-short, without narrowing LAD-proximal aneurysm (diam. ca 5-6mm), critical narrowings in med segment (90 and 75%) Cx-50-60% lesion in med segment. RCA: dominant, normal.

6. Intended strategy Guiding catheter: Judkins Left 4, 7F Stent graft Jostent 3.0x16mm on balloon 3.5x20mm Quantuum Predilatation of LAD and placement of a PTFE – covered stent Direct stenting to med Cx Guiding catheter: Judkins Left 4, 7F Stent graft Jostent 3.0x16mm on balloon 3.5x20mm Quantuum Predilatation of LAD and placement of a PTFE – covered stent Direct stenting to med Cx Technical data:

7. Stenting Administration of ticlopidine and ASA 2 days before procedure Routine anticoagulation during procedure. Predilatation and stent implantation to LAD (3.0 / 16mm Jostent coronary stent graft with 16 atm) Direct stenting to med Cx Administration of ticlopidine and ASA 2 days before procedure Routine anticoagulation during procedure. Predilatation and stent implantation to LAD (3.0 / 16mm Jostent coronary stent graft with 16 atm) Direct stenting to med Cx

8. Acute Result TIMI 3 flow after stent implantation Non significant residual stenosis No complication TIMI 3 flow after stent implantation Non significant residual stenosis No complication

9. Long-term sequel Acute MI after 6 months (late in-stent thrombosis) Successful thrombolysis combined with IIb/IIIa inhibitor. Acute MI after 6 months (late in-stent thrombosis) Successful thrombolysis combined with IIb/IIIa inhibitor.

10. Summary A 47 year old male with unstable angina was addmitted to the hospital for interventional diagnosis and treatment. Coronary angiography showed a LAD eccentric aneurysm and double-vessel coronary artery disease (LAD, Cx). The aneurysm and the lesion in proximal portion of LAD were treated with stent graft. The lesion more distally was treated with balloon angioplasty. Lesion in the Cx was stented. Patient left hospital on combined antiplatelet therapy with aspirin and ticlopidine ordered for 3 months. After 6 months patient suffered from anterior AMI caused by late in-stent thrombosis, which was successfully treated with thrombolysis and IIb/IIIa inhibitor. A 47 year old male with unstable angina was addmitted to the hospital for interventional diagnosis and treatment. Coronary angiography showed a LAD eccentric aneurysm and double-vessel coronary artery disease (LAD, Cx). The aneurysm and the lesion in proximal portion of LAD were treated with stent graft. The lesion more distally was treated with balloon angioplasty. Lesion in the Cx was stented. Patient left hospital on combined antiplatelet therapy with aspirin and ticlopidine ordered for 3 months. After 6 months patient suffered from anterior AMI caused by late in-stent thrombosis, which was successfully treated with thrombolysis and IIb/IIIa inhibitor.

11. Message Percutaneous coronary aneurysm closure with Jostent Graft is feasible and efficient. The use of this stent requires an extended course of double antiplatelet therapy. Percutaneous coronary aneurysm closure with Jostent Graft is feasible and efficient. The use of this stent requires an extended course of double antiplatelet therapy.