Coronary artery aneurysm: report of three clinical cases and literature review

Abstract

Background: Coronary artery aneurysm (CAA) is a rare anatomical entity associated with severe complications, including thrombosis, distal embolization, and acute myocardial infarction. Currently, the lack of large-scale clinical trials and standardized treatment guidelines poses significant challenges for clinicians in selecting optimal management strategies among medical therapy, percutaneous coronary intervention (PCI), or surgery. 

Objective: To report the clinical characteristics, imaging findings, and treatment outcomes of three distinct cases of coronary artery aneurysm, and to discuss appropriate management strategies based on these experiences. Case Reports: Case 1: A 69-year-old male presented with a localized saccular aneurysm in the left circumflex artery (LCx). Successful PCI was performed using a covered stent under intravascular ultrasound (IVUS) guidance. Case 2: A 68-year-old male presented with an aneurysm in the left anterior descending artery (LAD) involving a complex bifurcation. A multidisciplinary consultation led to the decision for coronary artery bypass grafting (CABG) combined with aneurysm ligation; postoperative recovery was uneventful. Case 3: A 61-year-old male was admitted with acute myocardial infarction and hemodynamic instability. Angiography revealed a giant aneurysm at the ostium of the LCx with a high thrombus burden. Despite thrombus aspiration and intensive medical therapy, the patient deteriorated and died before definitive surgery could be performed.

Conclusion: The management of coronary artery aneurysms requires an individualized approach based on anatomical and clinical characteristics. Endovascular intervention is effective for localized lesions, whereas surgery is preferred for complex anatomical presentations. Acute cases involving significant thrombus burden carry a poor prognosis and necessitate close multidisciplinary coordination.