Mr. Kao, is a 28-year-old male, and has no systemic diseases before. He suffered from intermittent chest tightness and dyspnea for 3 days.The symptoms got worse when walking, and relieved after rest.

ECG showed Sinus rhythm, and biphasic T wave in precordial leads.The lab data:  CPK= 351 U/L, CK-MB= 30 U/L, Troponin-I= 0.447 ng/ml.  NT-pro BNP= 1033 pg/ml.

CAG showed(1) LM: Aneurysm.(2) LAD: Aneurysm in the proximal part, then critical lesion the middle part.(3) Ramus: Aneurysm.(4) LCx: Ectasia.(5) RCA: Aneurysm in the Orifice, and then total occlusion, only collateral circulations to distal RCA. 
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Initially we dilated the critical lesion with balloon 2.0x15 mm in the left anterior descending artery.Then we used IVUS to evaluate the left anterior descending artery, and it revealed aneurysm diameter around 5.0~7.0 mm.We predilated with balloon 3.5x12 mm.Afterward, we deployed a drug-eluting stent 3.5x16 mm.The we performed post-dilatation with non-compliant balloon 5.0x8 mm after IVUS evaluation of the the proximal aneurysm size.The final coronary angiogram showed good stent apposition and distal flow. 

 


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Final (2).mp4

(1) Clinical presentations of coronary artery ectasia (CAE) vary widely, from asymptomatic cases to high-risk ACS. (2) Treatment should be personalized on the basis of the location, size, and morphology of coronary artery aneurysms (CAAs); the presence of thrombi; and the clinical characteristics of patients. (3) The optimal treatment approach remains to be identified.