A Case Report of a Coronary Artery Aneurysm as a Rare Complication of Percutaneous Coronary Intervention

A 60-year-old man presented with typical chest pain of the New York Heart Association function class III. The patient mentioned a history of stroke, hypertension, hyperlipidemia, and gastrointestinal bleeding. Angiography revealed a total cut in the mid-portion of the left anterior descending (LAD), a total cut in the ostial portion of the second branch of the diagonal branch of the left circumflex artery (LCX) as well as significant segmental stenosis in the mid-portion of the LCX, and also a significant lesion in the mid-portion of the right coronary artery (RCA). He was scheduled for a multivessel percutaneous coronary intervention (PCI). The LAD was wired with a 0.014-PILOT 150 guidewire, and 2 drug-eluting stents were deployed in the LAD. Six weeks later, the patient experienced chest pain again, despite receiving full medical treatment. The next angiography showed an unexpected pseudoaneurysm, in the mid-portion of the LAD exactly at the site of the stenting performed in the previous PCI. We considered coronary artery bypass grafting given the high possibility of thrombosis in the LAD and the presence of lesions in the RCA and the LCX. Conclusions Coronary aneurysms, albeit rare after PCI, can be life-threatening complications. Early diagnosis can be lifesaving. Chest pain after any intervention should flag up complications, especially in the absence of response to medical treatment. Regular follow-ups are the key to the diagnosis of any complications in the golden time for treatment. (Iranian Heart Journal 2020; 21(2): 84-89)