Coronary artery aneurism: a clinical case

Abstract

INTRODUCTION: Coronary artery aneurysm is a local dilatation of vessel 1.5–2-fold the initial diameter. In more than 40%, an aneurism is located in the right coronary artery, the next most common locations are the anterior interventricular artery and circumflex artery. An aneurism of the left coronary artery is a very rare finding seen in approximately 0.1% of patients. It is believed that in more than 50% of cases, coronary artery aneurisms develop with the underlying atherosclerosis, in 20–30% of cases they are hereditary, and in 10–20% of cases they are described in association with inflammatory diseases. Although thrombosis inside the cavity of aneurism may lead to distal embolization and development of myocardial infarction even in the absence of atherosclerosis of coronary arteries, its existence is not in all cases the indication for surgical treatment and in most cases decision on surgical approach is dictated by the severity of the coronary artery disease. In the given work, a clinical case of a patient with an aneurism of the left coronary artery is presented that developed after stenting with a bare metal stent. In our opinion, factors that influenced formation of aneurism in this clinical case were a dynamic impact of the blood flow on the damaged wall of the left main coronary artery through the holes in the stent, absence of endothelization of the implant surface in result of interaction of different biochemical and molecular-genetic mechanisms. CONCLUSION: Coronary artery aneurisms are not sufficiently studied and require investigations in the following directions: etiology and pathogenesis; optimal surgical treatment methods; place of conservative therapy in asymptomatic patients.