Novel insights into an old controversy

Abstract

Coronary artery ectasia (CAE) is defined as a localized or diffuse non-obstructive lesion of the epicardial coronary arteries with a luminal dilation exceeding 1.5-fold the diameter of the normal adjacent arterial segment. The incidence of CAE has been reported to range between 2% and 4%, which might be an overestimation of the true frequency. The coincidence of CAE with other systemic vascular dilatations has suggested that the mechanism underlying CAE is not only localized to coronary arteries, but also to other vascular compartments such as aorta or peripheral veins. Although the pathophysiology of CAE remains largely unknown, it was supposed to represent a variant of coronary atherosclerosis. This review focuses on this controversy of whether CAE and coronary artery disease (CAD) are two manifestations of the same underlying process. There are clear differences between CAD and CAE with respect to cardiovascular risk factors such as diabetes mellitus, and pathogenic steps in disease progress such as inflammation or extracellular matrix remodeling. As this review will underscore, the current knowledge of the field is insufficient to finally clarify the causative interrelation between CAE and CAD. The clinical course and treatment of CAE mainly depends on its coexistence with CAD. When coexisting with CAD, the prognosis and treatment of CAE are the same as for CAD alone. In isolated CAE, prognosis is better and anti-platelet drugs are the mainstay of treatment. Surgical treatment can be considered in selected patients. For clarifying the mechanism underlying CAE, additional clinical, histopathological and pathophysiological investigations are required. In fact, every patient with CAE should be evaluated systematically for pathological changes in other vascular territories, both in the arterial system as well as in the venous system, which might occur in the disease process.

Assessment of the relationship between coronary artery ectasia and erectile function score

“…18 This study also found a statistically significant relation between CAE and IIEF-5 score, confirming all the studies above. In conclusion, however atherosclerosis is one of the responsible mechanisms in CAE, actual cause of ectasia is unknown.…”

“…18 Histopathological characteristics of CAE are similar to those of coronary atherosclerosis, so it is not surprising that hypotheses for the origin of CAE revolve around the vascular endothelium and the biological properties of the arterial wall. Nevertheless, the specific causative mechanism of abnormal luminal dilatation in CAE remains unclear.…”

Clinical characteristics and coronary features of coronary ectasia and aneurysm in China

“…The previous study showed that 50% of patients with CEA also have concomitant atherosclerosis [9], with a most frequently involved branches of RCA, followed by LAD and LCX [2,4], while ectasia of multivessels and LM were rare [9]. However, CEA with atherosclerosis only occurred in 28% of the present study, while isolated CEA were observed in more than 70% patients, strongly supporting a recent viewpoint that CEA was not a simple variant of atherosclerosis [10]. Moreover, LAD is the most commonly involved artery, multiple coronaries and LM involvement observed in about 2/3 and 1/4 patients in the present study, respectively.…”

Impact of insulin like growth factor-1 in development of coronary artery ectasia

“…Several studies have evaluated the traditional cardiovascular risk factors in patients with CAE, and male dominance, younger age, hypertension, dyslipidemia, smoking, cocaine use, low prevalence of diabetes and persisting congenital anomaly, which included bicuspid aortic valve, aortic root dilatation, ventricular septal defect, pulmonary stenosis or cyanotic congenital heart disease have been implicated [6]. Th e frequent coexistence of CAE with CAD and histopathological fi ndings resembling those of atherosclerosis have led to the conclusion that the mechanism underlying the pathogenesis of CAE is a variant of atherosclerosis but there are some diff erences between CAE and CAD.…”

“…In most cases, CAE is found to coexist with CAD, whereas in 10-20 of cases, it is associated with cocaine abuse, toxins, infl ammation, infections, infl ammatory diseases, cardiac lymphoma and connective tissue disorders such as Kawasaki disease, systemic lupus erythematosus, Marfan syndrome, and Ehlers-Danlos syndrome [6][7][8][9][10]. In histopathological appearance of the disease, marked destruction and reduction of the medial elastic fi bers with disruption of the internal and external elastic lamina, smooth muscle hyalinization of the coronary fi bro-muscular media, excessive nitric oxide (NO) production which leads to hyalinization by indirect acetylcholine production have been found [6][7][8][9][10]. Severe coronary wall infl ammation may play a role in CAE pathogenesis [10,11].…”