Management of pseudoaneurysm following primary percutaneous coronary intervention

Coronary pseudoaneurysm followi ng drug-eluting stent implantation is rare but potentially life-threatening. We report a case of a 55-year-old man with diabetes and hypertension who presented with rest-induced angina three months after percutaneous coronary intervention. Angiography revealed in-stent restenosis with a pseudoaneurysm in the left anterior descending artery. The pseudoaneurysm was successfully treated using a covered stent under intravascular ultrasound (IVUS) guidance. Angiogram showed complete exclusion of the aneurysm and restoration of TIMI-3 flow. This case highlights the role of IVUS-guided covered stent placement as a safe alternative to surgery in selected patients with coronary pseudoaneurysm. • Rare case of coronary pseudoaneurysm after drug-eluting stent implantation. • IVUS guidance enabled precise localization and stent deployment in this case. • The covered stent and drug-eluting balloon avoided surgical intervention.