Coronary artery aneurysm: A review

Abstract

Coronary artery aneurysm (CAA) is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment. Atherosclerosis is the main cause in adults and Kawasaki disease in children. CAA is a silent progressive disorder incidentally detected by coronary angiography, but it may end with fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation and distal embolization. The pathophysiological mechanisms are not well understood. Atherosclerosis, proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation. Data from previously published studies are scarce and controversial, thereby the management of CAA is individualized depending on clinical presentation, CAA characteristics, patient profile and physician experience. Multiple therapeutic approaches including medical treatment, covered stent angioplasty, coil insertion and surgery were described. Herein, we provide an up-to-date systematic review on the pathophysiology, complications and management of CAA.

Double Whammy: Subacute Stent Thrombosis While Being Adherent to Dual Antiplatelet Therapy Including Ticagrelor, Followed by Multiple Coronary Artery Aneurysms in a COVID-19 Patient

“…Another rare aspect of our case was the occurrence of multiple CAA at the site of bifurcation stenting as demonstrated by the check angiography performed at six weeks of DES implantation. The predominant cause of CAA after DES implantation is postulated to be the occurrence of hypersensitivity to the DES polymer leading to a local vasculitis, many months after the DES implantation when the drug completely elutes from it [ 2 , 3 ]. In our case, Xience everolimus-eluting stents were used, which have a drug elution time of 120 days [ 18 ].…”

“…The occurrence of coronary artery aneurysms (CAA) after percutaneous coronary intervention (PCI) is a rare event, with various possible etiological factors including mechanical trauma during PCI, coronary dissection, balloon/stent oversizing, high-pressure balloon dilatation, use of atherectomy/laser angioplasty, stent mal-apposition, delayed re-endothelization, and local hypersensitivity reaction to the DES polymer [ 2 ]. Non-PCI-related causes of CAA include atherosclerosis, vasculitis syndromes (like Kawasaki’s disease, Takayasu's arteritis, polyarteritis nodosa, systemic lupus erythematosus), connective tissue disorders (like Marfan’s syndrome, Ehlers-Danlos syndrome), and infections (like bacterial, fungal, HIV) [ 3 ].…”

Evaluation of Coronary Atherosclerosis in Patients with Coronary Artery Aneurysm With CAD-RADS Scoring System Using MDCT Angiography

“…The pathophysiological mechanisms of CAA are not well understood, but atherosclerosis in adults and Kawasaki disease in children are the main etiologies (12). Other common causes of CAA include mycotic and infectious septic embolism, Marfan syndrome, and connective tissue diseases.…”

“…It is known that atherosclerosis, proteolytic imbalance, and inflammatory reactions play a role in aneurysm development. The ideal treatment for CAA has not been defined yet, but computed tomography angiography, a non-invasive method, is recommended for long-term follow-up (12,13). Coronary magnetic resonance angiography (MRA) can also be used for diagnosis and long-term follow-up, but MDCT angiography is considered to be superior (14).…”

The Biofabrication of Diseased Artery In Vitro Models

“…The aneurysm is defined as a local globular dilation of a normal artery that is about 1.5 times larger than the diameter of a normal adjacent segmentary artery [160,161]. Clinically, atypical aneurysms can be divided into three types [106]: (1) the expansion of the entire tube wall and lumen, namely mycotic aneurysm; (2) a laminar tear in the wall of the tube that causes the lumen to widen, called a dissecting aneurysm; (3) the blood vessel ruptures, the sub-adventitia hematoma forms a tumor-like dilation, and the tumor expands outside the wall, though the true lumen is not large, which is a pseudoaneurysm [162].…”