A case of progressive giant coronary aneurysm following first-generation drug-eluting stent implantation for chronic total occlusion-a case report and literature review

Coronary artery aneurysm (CAA) is a segmental dilation of the coronary artery and a rare condition. The incidence of CAA after drug-eluting stent (DES) implantation is 0.2%–2.3%, with giant coronary artery aneurysm (GCAA) being even rarer, occurring in approximately 0.02% of cases. We report a case of a 46-year-old female who presented with paroxysmal precordial pain in 2010. Coronary angiography was performed, and four sirolimus-eluting stents (FireBird) were implanted. Over the following decade, she experienced multiple acute coronary ischemic events. Repeat angiography revealed that coronary aneurysms had developed at all original stent implantation sites and were progressively enlarging. The patient ultimately underwent surgical treatment and recovered well during one year of follow-up. This rare case of stent-related GCAA suggests that treatment decisions should comprehensively evaluate the patient's specific conditions, including the recurrence of thrombotic events, the efficacy and safety of antithrombotic therapy, as well as the location and size of the aneurysm.