-
JACC. Cardiovascular Interventions Jul 2018Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography. Due to their poorly elucidated underlying mechanisms, their... (Review)
Review
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 -
Current Cardiology Reviews 2016Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. Its incidence ranges from 1.2%-4.9%. Coronary artery ectasia likely represents an... (Review)
Review
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 -
Archives of Cardiovascular Diseases Jan 2020Coronary 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... (Review)
Review
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 -
Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR).International Journal of Cardiology Jan 2020Coronary 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... (Clinical Trial)
Clinical Trial
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 -
Polskie Archiwum Medycyny Wewnetrznej Dec 2008Coronary aneurysms represent anomalies identified in 0.15-4.9% of patients undergoing coronary angiography. At present there is no uniform definition of this pathology.... (Review)
Review
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 -
Hellenic Journal of Cardiology : HJC =... 2021Coronary artery aneurysms (CAAs) are infrequent but not rare. Because of the lack of supportive data and a substantial knowledge gap in this field, clinicians are in a... (Review)
Review
Coronary artery aneurysms (CAAs) are infrequent but not rare. Because of the lack of supportive data and a substantial knowledge gap in this field, clinicians are in a dilemma how to manage patients with coronary artery aneurysms. Most often, CAAs are discovered incidentally, while symptomatic patients present with diverse complications of unstable angina, myocardial infarction, arrhythmias, or sudden cardiac death. Therapeutical approaches consist of surgical procedure, percutaneous coronary intervention (PCI), and medical management. Because of the scarcity of randomized trials or large-scale data on symptomatic and asymptomatic patients with coronary artery aneurysms, the management of these patients poses considerable challenges for the cardiologists. This review summarizes the current literature, a proposed algorithm for the management of CAAs is highlighted in the text. In view of the majority of current proposal information based on small series of case reports or observational studies, an individualized therapeutic regimen should be on the basis of the location, expansion by time, morphology, complications, and etiologies of the coronary artery aneurysms, the clinical presentations, and the patient's characteristics.
Topics: Coronary Aneurysm; Coronary Vessels; Humans; Myocardial Infarction; Percutaneous Coronary Intervention
PubMed: 32937198
DOI: 10.1016/j.hjc.2020.09.004 -
Archives of Pathology & Laboratory... May 2008Coronary 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... (Review)
Review
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 -
The Journal of Invasive Cardiology Sep 2021A patient was referred for aortic valve replacement and aneurysm resection; however, the aneurysm was deemed to be non-resectable due to severe calcification, thus...
A patient was referred for aortic valve replacement and aneurysm resection; however, the aneurysm was deemed to be non-resectable due to severe calcification, thus posing a high operative risk. The patient eventually underwent transcatheter aortic valve implantation. Eleven years later, coronary angiography depicted a giant coronary artery aneurysm measuring 63 mm in diameter and containing intraluminal thrombus. To our knowledge, this is the largest giant coronary artery aneurysm reported in the literature.
Topics: Coronary Aneurysm; Coronary Angiography; Coronary Vessels; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 34473076
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Oct 2023
Topics: Humans; Coronary Vessels; Coronary Aneurysm; Coronary Angiography
PubMed: 37874060
DOI: 10.4045/tidsskr.23.0315 -
Brazilian Journal of Cardiovascular... May 2022We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the...
We present an unusual case of a 67-year-old woman with an incidental finding of a cardiac mass on a chest computed tomography. Coronary angiotomography confirmed the diagnosis of right coronary artery aneurysm, with 5.7×5.7 cm. The patient underwent aneurysm resection and coronary bypass surgery, with subsequent histologic study suggestive of arteritis sequelae. Giant coronary artery aneurysms have a high risk of complications and aneurysm exclusion must be beneficial. This is a rare condition that can also be part of a systemic inflammatory disease.
Topics: Aged; Coronary Aneurysm; Coronary Artery Bypass; Coronary Vessels; Female; Humans; Tomography, X-Ray Computed
PubMed: 35503700
DOI: 10.21470/1678-9741-2020-0649