TREATMENT OF A CORONARY PSEUDOANEURYSM BY STENT-GRAFT IMPLANTATION

History and clinical findings: A 54-year-old man was urgently admitted because of sudden onset of progressively worsening angina pectoris, h is first attack. Physical examination was unremarkable. Investigations : Electrocardiography and laboratory tests excluded acute myocardial i nfarction. With the exception of hypercholesterolemia (toal cholestero l 247 mg/dl) laboratory tests were normal. Coronary angiography reveal ed a 60% eccentric narrowing in the proximal part of the interventricu lar branch with adjacent aneurysmatic dilatation. Intravascular ultras ound (IVUS) showed a coronary pseudoaneurysm, its cavity communicating with the empty atheroma hole of an adjacent ruptured coronary plaque. Treatment and course: A 19 mm stent graft was implanted, via a percut aneously inserted balloon-catheter system, in the region of the stenos is and the pseudoaneurysm. Subsequent angiography demonstrated a smoot h nonstenotic lumen. The membrane of the graft (made of polytetrafluor oethylene [PTFE]), fixed between two thin metal stents, had occluded t he pseudoaneurysm. Occlusion of an immediately distal septal branch br iefly produced an asymptomatic rise of creatine kinase to maximally 17 3 U/l. Oral medication included ticlopidine hydrochloride (2 x 250 mg daily for 4 weeks). The patient was symptom-free after the procedure a nd was discharged 5 days later. Conclusion: Implantation of a new type of stent-graft provides quick and uncomplicated treatment of a corona ry aneurysm. The membrane fixed between two stents prevents wash out o f any thrombi. The method may also be applicable to other potentially thrombus-containing lesions.