Fate of an Aneurysmal Left Main Chronic Total Occlusion

Document Type : Case Report


1 Interventional Cardiologist, Erfan General Hospital, Tehran, IR Iran.

2 Rutgers University, Rutgers NJMS, United States.

3 Nikan General Hospital, Tehran, IR Iran.

4 Cardiovascular Intervention Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


A 45-year-old woman presented to our cardiology clinic because of recent exertional chest discomfort. The patient had a history of the surgical repair of a secundum-type atrial septal defect in adolescence and the surgical repair of aortic regurgitation, followed by an emergent coronary artery bypass grafting operation due to electrocardiographic changes after aortic valve repair. Primarily, we evaluated the patient’s coronary tree with computed tomography angiography, which showed occluded grafts. Subsequently, coronary angiography revealed a chronic total occlusion in the left main with an aneurysmal formation and occluded grafts. Unfortunately, the surgical team refused to perform surgery. Accordingly, given her multiple prior surgeries, a percutaneous intervention was our last resort. We performed successful revascularization on the left main via the retrograde approach. Nonetheless, a year later, the patient needed another percutaneous intervention due to the progression of the left main aneurysm. The last follow-up demonstrated the patient’s acceptable clinical condition and physical activity without remarkable limitations. (Iranian Heart Journal 2023; 24(1): 86-90)


  1. Wu EB, Chan WW, Yu CM. Left main stem rupture caused by methicillin resistant Staphylococcus aureus infection of left main stent treated by covered stenting. Int J Cardiol 2009.
  2. Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: A review. Echocardiography 2004; 21:175–182.
  3. Atik FA, Navia JL, Vega PR, Gonzalez-Stawinski GV, Alster JM, Gillinov AM, Svensson LG, Pettersson BG, Lytle BW, Blackstone EH. Surgical treatment of postinfarction left ventricular pseudoaneurysm. The Annals of thoracic surgery. 2007 Feb 1; 83(2):526-31.
  4. Dhakam S, Ahmeed H, Jafarani A. Percutaneous coronary intervention of left main pseudoaneurysm with customized covered stents. Catheterization and Cardiovascular Interventions. 2011 Jun 1; 77(7):1033-5.
  5. Mishra A, Sirasena T, Slaughter R, Pohlner P, Walters DL. Percutaneous treatment of an occlusive left main pseudoaneurysm: a role for multimodality imaging. Cardiovascular Revascularization Medicine. 2011 Mar 1; 12(2):133-e7.
  6. Rahman S, Abdul-Waheed M, Helmy T, Huffman LC, Koshal V, Guitron J, Merrill WH, Lewis DF, Dunlap S, Shizukuda Y, Weintraub NL, Meyer C, Cilingiroglu M. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography. J Cardiothorac Surg 2009;4:15.
  7. Tapias LF, Campbell J, Rosenfield K, D'Alessandro DA. Pseudoaneurysm of the left main coronary artery: A complication of orbital atherectomy. Catheterization and Cardiovascular Interventions. 2018 Sep 1; 92(3):507-10.
  8. Spiliotopoulos K, Yanagawa B, Crean A, Overgaard C, Brister SJ. Surgical management of a left anterior descending pseudoaneurysm related to Behcet's disease. The Annals of thoracic surgery. 2011 Mar 1; 91(3):912-4.
  9. Pande AK, Kasliwal RR, Trehan N. Spontaneous primary coronary artery dissection leading to pseudoaneurysm. Int J Cardiol 1993; 42:97–99.
  10. von Birgelen C, Haude M, Liu F, Ge J, Gorge G, Welge D, Wieneke H, Baumgart D, Opherk D, Erbel R. [Treatment of coronary pseudoaneurysm by stent-graft implantation]. Dtsch Med Wochenschr 1998; 123:418–422.