ACI 2018 - Best of the Young - When Nothing Fits - Saud Khawaja

1. Giant Coronary Aneurysm
Dr. Hesham Abdelaziz
Dr. Billal Patel
Lancashire Cardiac Centre
Blackpool Victoria hospital
Advanced Cardiovascular Intervention
London 2018

2. • 72 years male with recent varicose vein operation.
• Admitted with Breathlessness and pneumonia.
• Worsening of dyspnea and becoming unwell.
• Echo pericardial effusion (consistency and appearance
looks like blood) with compression of RV.
• Urgent CT scan chest acute pericardial hemorrhage
with RV compression.
• Surgical evacuation of hematoma RCA aneurysm found
but no evident of active bleeding.
• Few days later in CITU massive bleeding in drains
shock emergency sternotomy in CITUruptured RCA
aneurysmsurgical repair of aneurysm but unable to
graft the RCA due to adhesions.
• CT CA Giant RCA aneurysm (22x27 cm).
• MDT for high risk PCI as aneurysm was still liable to re-
bleed again.

3. CT CA Mycotic RCA aneurysm (22x27 cm)

5. Finecross+ sion blue wire Twinpass + sion blue wire through the side
Port trying to get through the distal opening
of the aneurysm into the distal RCA

6. 2 orthogonal angiogram views showing that the wire was not in the proper
alignment with the distal opening of the aneurysm.
- Spend a lot of time trying to find the exit of the aneurysm into the distal vessel

7. Complete 360 degree loop of the sion blue wire inside the aneurysm
-Successful exit into the distal RCA

8. Complete loop of the wire
Finecross+ exchange for grand
Slam wire
Guideliner + 3.0x15 mm balloon
To straighten the wire loop

9. Balloon assisted guideliner tracking
Into distal RCA
Xience 3.5x48 mm as a scaffold which covered
Both the entrance and the exit sites of the
aneurysm
Posdilated proximal and distal part with 4.0 NC

10. -Positioning of 2 Aneugraft covered stent 4x 27 mm
- Post dilated with 4.0 NC at high pressure

11. -Results after the covered stents
-proximal perforation in the native RCA that
To seal by repetitive balloon tamponade
Positioning of a third covered stent
4.0x 18 mm that post-dilated with
4.5 NC at high pressure

12. Final results angiographically and by IVUS