March 19, 2026
A Mayo Clinic multidisciplinary team of experts describe the successful first-in-world use of an intrasaccular flow disruptor to treat a patient with a large saccular coronary artery aneurysm of the left main artery. The case report was published in JACC: Cardiovascular Interventions. Mayo Clinic experts have since performed two subsequent additional successful cases.
The flow disruptor device is a woven frame used to treat bifurcation aneurysms in the brain. This first-time use in the heart highlights how Mayo Clinic is expanding effective options and positive outcomes for patients.
"There is considerable excitement about these successful cases because until now we haven't had good options," says Rajiv Gulati, M.D., Ph.D., an interventional cardiologist and the chair of Interventional Cardiology and Ischemic Heart Disease at Mayo Clinic in Rochester, Minnesota. Dr. Gulati was senior author of the case report. "These saccular aneurysms are not accessible to the cardiac surgeon and have not been ideal for treatment with standard endovascular techniques. We now have an option to safely, quickly and efficaciously address these rare but serious cases."
Filling a therapeutic gap
Treating saccular coronary aneurysms is challenging since there isn't a dedicated device therapy. Plus, the anatomy frequently involves branch vessels or bifurcations. "Conventional PCI strategies often require multiple implants or risk compromise of the native vessel. Management remains individualized and technically demanding, largely due to the absence of randomized data and formal treatment guidelines," says Jason H. Anderson, M.D., an interventional cardiologist and director of the Congenital Catheterization lab at Mayo Clinic in Rochester, Minnesota, and one of the case report authors.
The novel treatment strategy was prompted by the initial and now published complex saccular coronary artery aneurysm case that Drs. Gulati and Anderson reviewed together. Traditional approaches including stent exclusion, coil embolization and occlusion devices were considered, but the anatomy raised concern for side branch compromise and incomplete exclusion. "The aneurysm morphology strongly resembled a bifurcation aneurysm commonly treated in intracranial circulation. We consulted with our neurointerventional radiology colleague. Given the shared physiologic principles between cerebral and coronary circulation, particularly the need to preserve adjacent vascular perfusion, we felt this paradigm could be translated safely to the coronary setting," Dr. Anderson says.
"I was surprised by the imaging because it looked like the cerebral aneurysms that we treat every day in neurointervention. If this aneurysm was in the brain, my first choice for treatment would be to use an intrasaccular flow disruptor," says Waleed Brinjikji, M.D., a neurointerventional radiologist at Mayo Clinic in Rochester, Minnesota, and an author of the case report. Dr. Brinjikji provided insight into the devices used for intrasaccular flow disruption in the brain.
"Rather than viewing this as a single device success, we see it as a shift in thinking. Coronary aneurysms, particularly complex saccular lesions, may be better approached using flow modification strategies instead of relying solely on mechanical exclusion with traditional coronary tools," Dr. Anderson says.
Alternative solutions
In the JACC: Cardiovascular Interventions case, the authors reported that:
- A 74-year-old male patient had a large saccular coronary artery aneurysm stemming from the distal left main bifurcation.
- Further multidisciplinary discussion led to the decision to implant an intrasaccular flow disruptor.
- The device was easily delivered, positioned and then released in a standard manner.
- The patient tolerated the procedure well, without acute complications or coronary compromise.
- Follow-up computerized tomography angiography confirmed correct device placement without residual flow to the coronary aneurysm at day 1 and 6 months postprocedure.
"The subsequent additional cases completed involved unique anatomic presentations of saccular aneurysms, often located at bifurcation points or presenting with large sac dimensions that made conventional strategies less favorable," Dr. Anderson says. "Across all cases, we observed rapid flow stagnation and near complete occlusion within 24 hours without obstruction of adjacent vessels or extension of the device into the native lumen. Compared with prior approaches, particularly coil-based strategies, the procedures were more straightforward and required fewer implants while achieving predictable angiographic results."
These early cases show Mayo Clinic as a leader in innovation. "Mayo Clinic is the perfect ecosystem to solve these types of challenges. There are many opportunities for us to share ideas, allowing creativity to thrive," Dr. Brinjikji says.
Collaborative culture
Mayo Clinic experts consistently work together to find solutions and deliver successful outcomes for patients. "When physicians encounter uncommon anatomy or an unmet clinical need, another specialty may already have addressed similar challenges and developed technologies that can be adapted safely," Dr. Anderson says.
Collaboration between neurointerventional radiology and cardiology is common. "I've learned a great deal from my cardiology colleagues. Dr. Gulati taught me everything I know about radial access. Because of working with him, we transformed our neurointerventional practice to be almost all transradial," Dr. Brinjikji says.
Next steps
Larger collaborative studies will be essential to better understand procedural safety, long-term outcomes and ideal patient selection. "Future directions include development of prospective registries, refinement of imaging criteria to identify optimal anatomy and collaboration with industry partners to design coronary-specific devices that incorporate the advantages of current flow disruption platforms," Dr. Anderson says. "Current management of coronary aneurysms continues to rely largely on small case series rather than robust clinical trials, underscoring the need for continued investigation."
Development of this treatment approach came directly from collaboration between Mayo Clinic multidisciplinary teams. "It's one of Mayo Clinic's defining strengths. Care is not isolated within a single specialty but instead integrates expertise from interventional cardiology, congenital cardiology and neurointerventional radiology," Dr. Gulati says. "By combining perspectives across disciplines, we were able to translate an established neurovascular therapy into a novel coronary application. This collective approach continues to drive innovation and improve care for patients with complex cardiovascular disease."
For more information
Lane CM, et al. Novel treatment of left main bifurcation aneurysm with intrasaccular flow disruptor. JACC: Cardiovascular Interventions. 2025;18:2545.
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