Giant Coronary Artery Aneurysms Involving All Three Coronary Arteries: A Challenging Case Report

Guangyao Zhai^*Yanru Yang

• Beijing, Luhe Hospital Affiliated to Capital Medical University, Beijing, China

Background: Giant coronary artery aneurysms (GCAAs) are relatively rare lesions and are characterized by coronary dilatations greater than 8 mm in diameter. Atherosclerosis is the most common cause of stenoses and can manifest clinically from asymptomatic to acute myocardial infarction. Diagnosis and management are especially difficult because they are rare, may present in numerous ways, and require highly specialized techniques. Case Presentation: This paper discusses a 49 year old man who has potential cardiovascular risk factors including type 2 diabetes mellitus, hypertension, and a smoking history of more than 20 pack years. He was admitted in May 2021 with exertional chest pain and was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed a giant aneurysm in the three major arteries; LAD, LCX and RCA with measurements of 8.5 mm, 16 mm and 12.1 mm respectively. The PCI was performed with balloon angioplasty at the ostium of the PDA, but these efforts failed to alleviate the symptoms. The patient was put on dual antiplatelet therapy which includes aspirin and clopidogrel. He was re-admitted in November 2023 with Non ST segment elevation myocardial infarction (NSTEMI). Follow-up angiography revealed severe restenosis of the PDA ostium and despite multiple attempts, the guidewire could not cross the lesion. Due to technical complexity and the presence of residual symptoms, anticoagulant therapy was changed to clopidogrel and rivaroxaban for secondary prevention. Conclusion: This case is a good example of the diagnostic and therapeutic complexities of GCAAs, particularly if more than one coronary vessel is affected. Medical therapy with both antiplatelet and anticoagulation medications is still recommended when interventions fail. More specifically, individualized and This is a provisional file, not the final typeset article comprehensive management approaches are necessary for the best results, and more studies are required to define protocols for managing complicated GCAA cases.