Sol Ana Koroner Arter Anevrizmalarında Güncel Yaklaşımlar ve Klinik Yönetim
Özet
Sol ana koroner arter (LMCA) anevrizmaları, %0.1 prevalans ile nadir görülen ancak tromboz, distal embolizasyon ve rüptür riski nedeniyle kritik öneme sahip vasküler patolojilerdir. Bu sunumda, altı aydır devam eden tipik anjinal yakınmalarla başvuran 62 yaşında erkek hastada saptanan dev LMCA anevrizması ve klinik yönetimi ele alınmıştır. Yapılan koroner anjiyografi ve bilgisayarlı tomografi anjiyografide; LMCA proksimalinde 12.1 mm, sol anterior desendan arter proksimalinde ise 7.5 mm çapa ulaşan fuziform anevrizmatik dilatasyonlar izlenmiştir. Hastada yapılan miyokard perfüzyon sintigrafisinde iskemi saptanmaması ve koroner arterlerde belirgin obstrüktif lezyon bulunmaması üzerine, multidisipliner konsey kararıyla invaziv girişim yerine medikal takip stratejisi benimsenmiştir. Anevrizmanın fuziform morfolojisi ve düşük rüptür riski göz önünde bulundurularak, tromboembolik komplikasyonları önlemek amacıyla oral antikoagülan tedavi planlanmıştır. Bu olgu, dev LMCA anevrizmalarında tedavi kararının yalnızca anatomik boyuta değil, klinik ve fonksiyonel değerlendirmeye göre bireyselleştirilmesi gerektiğini ve seçilmiş hastalarda medikal tedavinin uygun bir seçenek olabileceğini göstermektedir.
Left main coronary artery (LMCA) aneurysms are rare vascular pathologies with a reported prevalence of approximately 0.1%; however, they are clinically important because of the risks of thrombosis, distal embolization, and rupture. We present the case of a 62-year-old male patient with a giant LMCA aneurysm who was admitted with typical anginal symptoms persisting for six months. Coronary angiography and computed tomography angiography demonstrated fusiform aneurysmal dilatations measuring 12.1 mm in the LMCA and 7.5 mm in the proximal left anterior descending artery. Myocardial perfusion scintigraphy revealed no evidence of ischemia, and no significant obstructive coronary artery disease was identified. Therefore, following multidisciplinary heart team evaluation, a conservative medical management strategy was preferred over invasive intervention. Considering the fusiform morphology of the aneurysm and its presumed low risk of rupture, oral anticoagulant therapy was initiated to reduce the risk of thromboembolic complications. This case highlights that treatment decisions in giant LMCA aneurysms should be individualized based not only on anatomical size but also on clinical and functional assessment, and that medical therapy may represent an appropriate treatment option in selected patients.
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