A Case Study of Chronic Coronary Syndrome Revealing a Proximal Left Anterior Descending Artery Aneurysm

Context: Coronary artery aneurysms (CAA) are rare entities associated with significant clinical consequences, including thrombotic occlusions. Chronic coronary syndrome (CCS) may reveal CAA, complicating patient management, particularly when associated with coronary thrombosis. This case discusses a 55-year-old male presenting with angina and dyspnea, later found to have a proximal left anterior descending artery (LAD) aneurysm with thrombotic occlusion.

Case Presentation: A 55-year-old male with a history of hypertension, diabetes, and hyperlipidemia presented with exertional chest pain and dyspnea over three months. Coronary angiography revealed a large proximal LAD aneurysm with thrombotic occlusion of the mid-LAD (type B1).

Initial management included thromboaspiration and stent placement, followed by dual antiplatelet therapy (DAPT). Despite recanalization, the patient developed a no-reflow phenomenon, managed with vasodilators and anticoagulation.

Conclusion: CAA can complicate the course of coronary syndromes, especially when associated with thrombosis. Percutaneous intervention can be successful, but complications like reocclusion and no-reflow may require intensive management strategies.