Review

Authors: Akram Kawsara, Iván J Núñez Gil, Fahad Alqahtani...

Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of largescale outcome data on their various treatment modalities, coronary artery aneurysms and coronary ectasia pose a challenge to the managing clinician. This paper aims to provide a succinct review of aneurysmal coronary disease, with a special emphasis on the challenges associated with its interventional treatment.

Topics: Cardiac Surgical Procedures; Cardiovascular Agents; Coronary Aneurysm; Coronary Artery Bypass; Humans; Ligation; Percutaneous Coronary Intervention; Risk Factors; Stents; Treatment Outcome

PubMed: 29976357
DOI: 10.1016/j.jcin.2018.02.041

Review

Authors: Subodh Devabhaktuni, Ana Mercedes, Jimmy Diep...

Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. Its incidence ranges from 1.2%-4.9%. Coronary artery ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth with atherosclerosis being the most common cause. Although, it has been described more than five decades ago, its management is still debated. We therefore reviewed the literature until date by searching PubMed and Google scholar using key words "coronary artery ectasia", "coronary artery aneurysm", "pathophysiology", "diagnosis", "management" either by itself or in combination. We reviewed the full articles and review articles and focused mainly on pathophysiology, diagnosis and management of CAE.

Topics: Atherosclerosis; Coronary Aneurysm; Dilatation, Pathologic; Humans; Plaque, Atherosclerotic; Risk Factors

PubMed: 27142049
DOI: 10.2174/1573403x12666160504100159

Review

Authors: Vincent Pham, Quentin de Hemptinne, Jean-Michel Grinda...

Coronary aneurysms are classically defined as a segment of the artery in which dilation exceeds the diameter of an adjacent portion (considered as a reference point) by more than 1.5times. In rare instances, coronary artery aneurysms are large enough to be called giant coronary artery aneurysms, which have been reported as occurring with an incidence of 0.02%. However, there is no clear consensus on how giant coronary artery aneurysms should be defined, and their aetiology is not entirely clear; many causes have been suggested, with atherosclerosis being the most common among adults, accounting for up to 50% of cases, and paediatric diseases, such as Kawasaki disease and Takayasu arteritis, being the other main aetiology. Although giant coronary artery aneurysms are often incidental findings, many complications, such as local thrombosis, distal embolization, rupture and vasospasm, associated with ischaemia, heart failure and arrhythmias, have been reported. The optimal medical, interventional or surgical management, still needs to be clarified. This literature review aims to summarize current knowledge on giant coronary artery aneurysms.

Topics: Cardiac Imaging Techniques; Coronary Aneurysm; Humans; Predictive Value of Tests; Risk Factors; Treatment Outcome

PubMed: 31866173
DOI: 10.1016/j.acvd.2019.10.008

Clinical Trial

Authors: Iván J Núñez-Gil, Enrico Cerrato, Mario Bollati...

BACKGROUND

Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes.

METHODS AND RESULTS

The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents.

CONCLUSIONS

Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.

Topics: Aged; Coronary Aneurysm; Coronary Angiography; Female; Follow-Up Studies; Humans; Internationality; Male; Middle Aged; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Registries

PubMed: 31378382
DOI: 10.1016/j.ijcard.2019.05.067

Review

Authors: Pei-Ni Jone, Adriana Tremoulet, Nadine Choueiter...

Kawasaki disease (KD), an acute self-limited febrile illness that primarily affects children <5 years old, is the leading cause of acquired heart disease in developed countries, with the potential of leading to coronary artery dilation and coronary artery aneurysms in 25% of untreated patients. This update summarizes relevant clinical data published since the 2017 American Heart Association scientific statement on KD related to diagnosis, cardiac imaging in acute KD treatment, and long-term management. Criteria defining North American patients at high risk for developing coronary artery aneurysms who may benefit from more intensive initial treatment have been published. Advances in cardiovascular imaging have improved the ability to identify coronary artery stenosis in patients with KD, yet knowledge gaps remain regarding optimal frequency of serial imaging and the best imaging modality to identify those at risk for inducible myocardial ischemia. Recent data have advanced the understanding of safety and dosing for several anti-inflammatory therapies in KD. New anticoagulation medication, myocardial infarction management, transition of health care for patients with KD, and future directions in research are discussed.

Topics: Mucocutaneous Lymph Node Syndrome; Humans; American Heart Association; United States; Coronary Aneurysm; Disease Management

PubMed: 39534969
DOI: 10.1161/CIR.0000000000001295

Review

Authors: Aneta I Gziut, Robert J Gil

Coronary aneurysms represent anomalies identified in 0.15-4.9% of patients undergoing coronary angiography. At present there is no uniform definition of this pathology. According to current definitions, the term "aneurysm" refers to both diffuse over 150% dilation of the largest diameter of a coronary artery, and limited spherical or saccular dilation. Aneurysms are observed most commonly in the right coronary artery, and least frequently in the left main coronary artery. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. However, regardless of the pathogenesis of the aneurysm, pathology of the media of the blood vessel plays a major role in its formation. The most prevalent consequence of aneurysms in the coronary arteries is formation of a thrombus with distal embolization, vasospasm or vessel disruption at the site of wall injury. Therefore, therapeutic management in this anomaly involves both the prevention of thromboembolic complications and percutaneous or surgical closure of the aneurysm entry.

Topics: Angioplasty, Balloon, Coronary; Atherosclerosis; Coronary Aneurysm; Coronary Angiography; Coronary Artery Bypass; Coronary Thrombosis; Dilatation, Pathologic; Humans; Mucocutaneous Lymph Node Syndrome; Regional Blood Flow

PubMed: 19202953
DOI: No ID Found

Review

Authors: Larry Nichols, Stephen Lagana, Anil Parwani...

CONTEXT

Coronary artery aneurysm is an uncommon condition that can be a cause of death when it thromboses or ruptures. It is always associated with destruction of the tunica media, usually associated with atherosclerosis, and commonly associated with chronic inflammation.

OBJECTIVE

To review the pathology, epidemiologic and clinical features, and pathophysiology of coronary artery aneurysm, particularly new research results, drawing out implications for the understanding, diagnosis, and treatment of this condition.

DATA SOURCES

Pertinent literature and illustrative cases at our institution.

CONCLUSIONS

Inflammation spilling over into the tunica media from the tunica intima may link atherosclerosis to aneurysm formation, but vasculitis without atherosclerosis causes coronary artery aneurysms in young children with Kawasaki disease. Increased proteolysis of extracellular matrix proteins is probably one mechanism of coronary artery aneurysm formation, either due to overactive matrix metalloproteinases or underactive inhibition of these proteinases, and an excess of transforming growth factor beta may be another mechanism in the pathogenesis. Coronary atherosclerosis is a universal disease of adults, but only 1.5% of them have coronary aneurysms; this small group may be those with a second coronary artery disease, such as vasculitis.

Topics: Arteriosclerosis; Coronary Aneurysm; Coronary Vessels; Genetic Predisposition to Disease; Germany; Humans; United States

PubMed: 18466032
DOI: 10.5858/2008-132-823-CAAARA

Authors: Erik Madssen

Topics: Humans; Coronary Vessels; Coronary Aneurysm; Coronary Angiography

PubMed: 37874060
DOI: 10.4045/tidsskr.23.0315

Review

Authors: Sebastian Sobczak, Bogdan Jegier, Ludomir Stefanczyk...

Coronary artery aneurysm (CAA) is generally defined as coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The prime cause of CAAs is atherosclerosis, and the most commonly affected artery is the right coronary artery. CAAs are quite commonly detected during X-ray coronary angiography. However, Coronary artery aneurysm (CAA) is generally defined as coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The prime cause of CAAs is atherosclerosis, and the most commonly affected artery is the right coronary artery. CAAs are quite commonly detected during X-ray coronary angiography. However, giant CAAs, especially with the diameter exceeding 100 mm, are extremely rare. The treatment method of choice of giant CAAs is the excision of aneurysm with coronary artery bypass grafting. We present a case of a 41-year-old apparently healthy woman with a giant right CAA. This was detected by noninvasive methods, including magnetic resonance coronary angiography, and its maximum diameter exceeded 100 mm. In emergency, the aneurysmal sac was excised and the aortocoronary saphenous vein graft was performed. We also present a review of the published studies of giant CAAs with the diameter exceeding 100 mm.

Topics: Adult; Coronary Aneurysm; Coronary Artery Bypass; Female; Humans; Magnetic Resonance Angiography

PubMed: 25811209
DOI: 10.5144/0256-4947.2014.346

Review

Authors: Elena Emilia Babeş, Victor Vlad Babeş, Mihaela Mirela Zdrîncă...

We report an unusual case of a 70-year-old female patient admitted in the Department of Cardiology, Emergency County Hospital, Oradea, Romania, for unstable angina and heart failure. Coronary angiography and computed tomography revealed multiple coronary artery aneurysms, some of them giant, associated with significant coronary artery disease. Coronary artery aneurysm is a rare disease, but the frequency of diagnostic increased with the development of coronary angiography. However, very rarely coronary artery aneurysm is very large and can be termed "giant aneurysm", and a small number of reports have been described in literature. The management and the prognosis of the disease is still controversial.

Topics: Aged; Coronary Aneurysm; Female; Humans

PubMed: 33544808
DOI: 10.47162/RJME.61.2.26