Subacute development of a coronary artery pseudoaneurysm after primary angioplasty and stenting for acute myocardial infarction.

Three months after successful primary angioplasty with stent implantation for an acute myocardial infarction, we were confronted with an intra-stent pseudoaneurysm. It was located at the proximal part of the left anterior descending coronary artery and associated with an early severe restenosis on a marginal branch; the choice was made for surgical treatment. Despite a review of the literature and an examination of the procedural data, we were not able to explain the pseudoaneurysm. We assume that either the guidewire perforated the arterial wall when it cleared the occlusion or a non-angiographically visible dissection provoked this phenomenon.