Coronary spasm in patients with coronary ectasia

Suzuki, Hiroshi; Takeyama, Youichi; Hamazaki, Yoko; Namiki, Atsuo; Koba, Shinji; Matsubara, Hitoshi; Hiroshige, Juichi; Murakami, Mikitaka; Kubo, Takashi

doi:10.1002/ccd.1810320102

Cited by 30 publications

(18 citation statements)

References 19 publications

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“…Coronary artery ectasia can be associated with different complications, such as coronary spasm, exercise-induced myocardial ischemia, thrombosis within the aneurysms and distal embolization, coronary artery dissection, and rupture of the weakened wall [2,[51][52][53][54]. There is impaired coronary blood flow with delayed antegrade filling, segmental backflow (milking phenomenon) and stasis in the dilated segments with microvascular dysfunction [52,[55][56][57].…”

Section: Complicationsmentioning

confidence: 99%

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Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Dahhan

2015

Cardiovascular Therapeutics

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SUMMARYCoronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, b-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.

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Section: Complicationsmentioning

confidence: 99%

“…This is expected because of the destruction of the smooth muscle cells in the vascular media. Instead, vasospasm can be provoked at the borders of these noncontractile dilated segments [51]. Such border vasospasm can further decrease coronary blood flow velocity within the dilated segments and result in more thrombosis and ischemia.…”

Section: Complicationsmentioning

confidence: 99%

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Dahhan

2015

Cardiovascular Therapeutics

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“…Ektazik damarların histolojik incelemelerinde damarsal mediyal hasarın varlığı yanında, ektazik arterlerin spazma eğilimli oldukları belirlenmiştir (17). Ayrıca arterin ektazik bölgesine yakın alanlarda daralma varlığı tespit edilirken (18) ektazik damarda tromboz (19) ve disseksiyon (20) varlığını göste-ren vaka bildirimleri de mevcuttur. Daha yakın dönemde izole ektazili hastaların incelendiği bir çalışmada ergometri ve koroner sinüs laktat çalışmalarıyla egzersizle indüklenen miyokardiyal iskemi varlığı tespit edilmiştir (21).…”

Section: İstatistiksel Analizunclassified

Coronary artery ectasia: its frequency and relationship with atherosclerotic risk factors in patients undergoing cardiac catheterization

Aksu

Uygur²,

Koşar³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Koroner arter ektazisi (KAE), koroner arterlerin bölgesel ya da yaygın anevrizmal dilatasyonu olarak tanımlanır. Biz bu çalışmada merkezimizdeki KAE sıklığını belirlemeyi ve izole KAE ve koroner arter hastalığı (KAH)'nın eşlik ettiği KAE'li hastalar arasında klinik ve anjiyografik karakteristikleri karşılaştırmayı amaçladık.Yöntemler: Şubat 2004-Aralık 2005 tarihleri arasında koroner anjiyografi uygulanan 12.514 hastanın kayıtları geriye dönük olarak 2 bağımsız operatör tarafından değerlendirildi. Koroner arter çapları bilgisayarlı niceliksel anjiyografi ile ölçüldü. Tüm hastaların KAH risk faktörleri belirlendi. İstatistiksel analizde eşleştirilmemiş Student t-testi ve Ki-kare testi kullanıldı. Bulgular: İki yüz bir hastaya KAE tanısı konuldu ve insidansı %1.59 olarak belirlendi. Hastaların çoğunluğu erkekti (%78). Ortalama yaş 61±10.8 yıl idi (yaş aralığı, 25 ile 82 yıl). Vakalar izole KAE (Grup 1) (%14.9) ve KAH'ın eşlik ettiği KAE (Grup 2) (%85.1) olmak üzere 2 gruba ayrıldı. Gruplar KAH risk faktörleri yönünden karşılaştırıldığında oranlar benzerdi. Arteriyel tutulum sıklığı: Sağ koroner arter (RCA), %54.3; sirkumfleks arter (Cx), %48.3; sol ön inen arter (LAD), %40.4 şeklinde idi. KAE'li vakaların %64.2'sinde bir ana damarda tutulum varken, %9'unda her 3 damarda da tutulum mevcuttu. İzole KAE'de en yaygın Cx'te görülmekteydi (%53.3). Ektazi yayılımı modifiye Markis sınıflaması ve Harikrishnan sınıflaması ile belirlendi. En sık tutulum Markis tip 4 ve Harikrishnan tip 4a şeklinde idi. En sık klinik sunum şekli her iki grupta da atipik angina olmasına rağmen, akut koroner sendrom Grup 1'de daha fazlaydı (p=0.018). Sonuç: Her 2 hasta grubunda KAH risk faktörleri ve klinik başvuru şekilleri oldukça benzerdi ve bu durum ortak etyopatogenezi düşündürmek-teydi. (Anadolu Kardiyol Derg 2011; 11: 280-4) Anahtar kelimeler: Koroner ektazi, koroner arter hastalığı ABSTRACT Objective: Coronary artery ectasia (CAE) is defined as local or generalized aneurysmal dilatation of the coronary arteries. We aimed to determine the frequency of CAE at our center and to compare clinical and angiographic characteristics between patients with isolated CAE and CAE with coronary artery disease (CAD). Methods: From February 2004 to December 2005, 12.514 patients were retrospectively analyzed by two independent operators who underwent coronary angiography. Coronary artery diameters were measured using qualitative computed angiography. CAD risk factors were recorded for all patients. Unpaired Student's t-test and Chi-square test were used for statistical analysis. Results: CAE was diagnosed in 201 patients (1.59%). The majority (78%) were male. The mean age was 61±10.8 years (range, 25 to 82 years). The cases were divided into 2 groups as isolated CAE (Group 1) (14.9%) and CAE with CAD (Group 2) (85.1%). The risk factors of CAD were similar between two groups. The frequency of arterial involvement was: the right coronary artery (RCA) 54.3%; circumflex artery (Cx), 48.3%; the left anterior descending artery (LAD), 40.4%. CAE affe...

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“…19) The majority of cases of coronary artery spasm occur within or around the ectatic site of the epicardial artery, 17) and coronary vasospasm occurring in an area far beyond the ectatic site, as in our case, is thought to be rare.…”

Section: Discussionmentioning

confidence: 60%

“…15) As with the intravascular ultrasound images of the present case, the intravascular ultrasound images in two other reports on coronary artery ectasia indicate the presence of intimal thickening, suggesting an association with atherosclerosis. 14,16) A correlation between coronary artery ectasia and coronary vasospasm has also been reported 17,18) and a review article by Sorrell, et al recommended that patients with coronary artery ectasia should be treated with calcium channel blockers to prevent coronary vasospasm, in addition to warfarin and aspirin to prevent thrombus formation.…”

Section: Discussionmentioning

confidence: 98%

<b>Pure Ventricular Septal Myocardial Infarction in a Young Man With Coronary Artery Ectasia</b>

et al. 2006

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SUMMARYThe case of a 30-year-old man with myocardial infarction localized in the interventricular septum is described. Coronary angiography performed on day 28 after the onset of symptoms revealed ectasia in the right and left coronary arteries, but no overt stenotic or occlusive lesions were present. Spasm was induced in the first septal branch of the left anterior descending artery by an acetylcholine provocation test, and single photon emission computed tomography myocardial perfusion imaging showed a reduced thallium-201 uptake localized in the interventricular septum. (Int Heart J 2006; 47: 131-137) Key words: Coronary artery ectasia, Coronary vasospasm, Pure septal infarction PURE septal infarction is a rare type of myocardial infarction, 1) and is often difficult to diagnose from variations in the ECG patterns.2) On the other hand, there is a high incidence of vasospastic angina in the Japanese population and coronary vasospasm is thought to be heavily involved in the pathogenesis of acute myocardial infarction.3,4) Here, we report our experience of a rare case of pure septal infarction that may have been caused by coronary vasospasm provoked in the first septal branch of the ectatic left anterior descending artery in a 30-year-old man. CASE REPORTThe patient was a 30-year-old man with hypercholesterolemia who was a heavy smoker, had no history of collagen disease or Kawasaki disease, and no family history of coronary artery disease. The plasma levels of total cholesterol and low-density lipoprotein cholesterol were 294 and 160 mg/dL, respectively, but he had no history of familial hypercholesterolemia. He presented to our hosFrom the Departments of 1 Cardiology, and

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Coronary spasm in patients with coronary ectasia

Cited by 30 publications

References 19 publications

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Coronary artery ectasia: its frequency and relationship with atherosclerotic risk factors in patients undergoing cardiac catheterization

<b>Pure Ventricular Septal Myocardial Infarction in a Young Man With Coronary Artery Ectasia</b>

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