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GUIDELINES/RECOMMENDATIONS 📋 Case Report / Single-Patient Outcome
A Journal of Invasive Cardiology clinical images case documents transcatheter coil occlusion of a 51 x 39-mm partially thrombosed SVG aneurysm in a 70-year-old man 14 years after CABG. The procedure was technically successful, but the patient died hours after day-2 discharge from anterior MI; postmortem attributed the event to external LIMA compression by the aneurysm sack.
Clinical Considerations
- Preprocedural angiography identified the aneurysm with the LIMA-to-LAD graft patent but potentially externally compressed before coil deployment.
- Coronary CT angiography confirmed aneurysm dimensions and partial thrombosis, informing the transcatheter approach.
- Outflow was occluded with a single 4.0 x 10-mm peripheral vessel coil; inflow was occluded with multiple additional coils.
- The fatal outcome despite procedural success raises questions about post-procedure imaging surveillance and discharge timing when adjacent graft compression is identified.
Practice Applications
- Interpret single-case outcomes as mechanistic illustration, not generalizable evidence.
- Recognize external compression of adjacent grafts as a potential risk with large SVG aneurysms.
- Consider extended monitoring or post-procedure cross-sectional imaging when compression is identified preprocedure.
- Integrate aneurysm geometry and adjacent graft anatomy into transcatheter planning.
Related Summaries
