Coronary aneurysm formation after primary coronary angioplasty

We describe the case of a man who underwent primary angioplasty with stenting for acute myocardial infarction and subsequently developed a coronary artery aneurysm at the site of stent deployment. The aneurysm grew rapidly in size over a few weeks and required treatment with a covered stent. The use of intravascular ultrasound equipped with special software for colour blood flow imaging contributed significantly to the diagnosis as well as to the evaluation of treatment. The cause of the post-angioplasty aneurysm was probably a micro-dissection at the stent site that was not visible on conventional angiography. Given the possibility of the occurrence of aneurysms early after primary angioplasty, intravascular ultrasound can be useful for the diagnosis of possible residual intramural haemorrhage, ulcer, coronary dissection, or stent malapposition, which cannot be detected by conventional angiography.