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Volume 11 – Number 3 – October 2025

Coil embolisation of a large distal left anterior descending artery aneurysm

AsiaIntervention 2025;11:215-216 | 10.4244/AIJ-D-25-00011

Yerramareddy Vijayachandra, MD, DM, MRCP; Prakash Chandra Jain, MD, DNB; Antony Wilson, DM; Jayalakshmi Sreeram, DM; Aishwarya Mahesh Kumar, MDS

A coronary artery aneurysm is an enlargement of the coronary artery exceeding 1.5 times the diameter of the adjacent normal segment1. A 29-year-old man presented with retrosternal chest pain and exertional dyspnoea, which had been ongoing for 1 month. A coronary angiogram showed an ectatic left anterior descending artery (LAD) with aneurysmal dilatation of ≈3 cm diameter (Figure 1A, Moving image 1, Moving image 2). A cardiac computed tomography angiogram revealed a large contrast-filled aneurysm measuring 3.5 cm x 3.5 cm x 3.2 cm (Figure 1B), seen predominantly filling in the later arterial/delayed phase communicating with the distal LAD. The aneurysm was burrowed in the right ventricular apical myocardium with mild calcification. The patient underwent coiling of the distal LAD aneurysm with 4 coils (Concerto Helix [Medtronic]: 14 mm x 30 cm, 16 mm x 40 cm, 18 mm x 40 cm, 16 mm x 40 cm) (Figure 1C–Figure 1D–Figure 1E, Moving image 3) and was doing well at 1-year follow-up. Coil embolisation results in occlusion of the aneurysm, formation of organised thrombus, fibrosis, and eventual endothelialisation2.

Figure 1. Management of giant coronary aneurysm A) The coronary angiogram showed a jet of contrast into a giant coronary aneurysm from the left anterior descending artery (LAD) B) Cardiac computed tomography revealed the presence of a large aneurysm from the LAD burrowed in the apical myocardium of the right ventricle. C) The narrow mouth of the aneurysm was crossed with a balance middle weight (BMW) 0.014” guidewire (Abbott). D) The Progreat microcatheter (Terumo) was advanced into the aneurysm over a BMW 0.014” guidewire. E) Four Concerto detachable coils (Medtronic) were deployed: 3 inside the aneurysm and 1 at the end of the distal LAD. AO: aorta; LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle

Conflict of interest statement

The authors have no conflicts of interest to declare.

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References

  • Matta AG, Yaacoub N, Nader V, Moussallem N, Carrie D, Roncalli J. Coronary artery aneurysm: A review. World J Cardiol 2021;13:446-55
  • Ahmed T, Chahal D, Shkullaku M, Gupta A. Extensive coil embolization of a giant coronary artery aneurysm in an octogenarian: a case report. Eur Heart J Case Rep 2020;4:1-5

Volume 11 - Number 3

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Authors
  • Aishwarya Mahesh Kumar
  • Antony Wilson
  • Jayalakshmi Sreeram
  • Prakash Chandra Jain
  • Yerramareddy Vijayachandra
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