From atherosclerotic coronary ectasia to aneurysm: a case report and literature review

Abstract

In contrast to Kawasaki syndrome the formation of coronary aneurysms caused by atherosclerosis has hardly been demonstrated. We report on a 56-year old patient, admitted to our hospital for cardiovascular evaluation before carotid surgery. He had no anginal pain, but a history of coronary artery disease with previous anterior myocardial infarction. Angiography revealed a collateralized LAD occlusion. Myocardial scintigraphy only demonstrated fixed perfusion defects. Surprisingly, MR imaging revealed large coronary aneurysms of the RCX and RCA. Angiographic follow up showed a rapid progression of ectatic towards aneurysmatic coronary lesions within 3 years. General pathophysiological mechanisms promoting ectatic coronary artery disease as a structural failure of the atherosclerotic remodelling process itself and chronic dilatatory stimuli due to endogenous and exogenous factors are discussed.

Exclusion of Giant Coronary Artery Aneurysm with Covered Stent Combined with Coil Embolization of Vessel Outflow

“…Pre-existing CAAs of the native vessels have a propensity to enlarge in size following coronary artery bypass surgery. This is especially common in ectatic arteries [4]. In such situation, surgical resection of the aneurysm might not be an option and percutaneous treatment is a feasible alternative.…”

“…The effectiveness and long term outcomes to this technique will have to be studied with serial CT angiography. Primary criteria to assess the outcomes include [1] any potential recanalization with the coil embolization technique along with the regrowth of the sac, [2] intra-aneurysmal thrombosis formation, [3] thrombogenic issue with a stent graft, and [4] any potential luminal area reduction by tissue growth.…”

Evaluation of Multiple Coronary Artery Aneurysms in Kawasaki’s Disease by Whole Heart Non-Contrast Enhanced MRI

“…In contrast giant aneurysms progress and become obstructive lesions due to thrombus formation. Enlargement of a coronary aneurysm after the acute phase in Kawasaki disease is an extremely rare phenomenon [1][2][3]. Giant coronary aneurysms are sometimes misdiagnosed as cardiac tumors when they are filled with thrombus [4].…”

Pathophysiological and Clinical Significance of Coronary Artery Ectasia - A Review

“…Plehn et al preferred to use the term coronary artery aneurysm for segmental ectasia, reserving the term ectasia for diffuse vessel involvement. 12 They classified aneurysms as small (< 5 mm), medium (5-8 mm), or giant (e" 8 mm). In addition, coronary artery aneurysm has been classified as the fusiform or saccular type based on the anatomic shape of the ecstatic segment.…”

“…Plehn et al reported a patient who presented with ectatic lesions that rapidly progressed to aneurysmatic lesions within 3 years. 12 The patient was treated with aneurysm ligation and coronary artery bypass grafting (CABG). A coronary aneurysm was diagnosed if the internal lumen diameter was >4.0 mm.…”