Coronary Artery Aneurysm and Ectasia: Spectrum of Aetio-Pathology, Clinical Presentation and Outcome

Abstract

The terms coronary artery ectasia and coronary artery aneurysm are used to describe aneurysmal dilation of coronary arteries. Coronary artery aneurysms and ectasia are uncommon and frequently incidental finding in patients advised Coronary Angiography for coronary artery disease evaluation. Aneurysmal dilation of coronary arteries is observed in up to 5% of patients undergoing coronary angiography and are usually describe a localised dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. Aneurysms and ectasia are associated with a vast group of disorders, and the evaluation and characterization of coronary aneurysms and ectasia represent a great diagnostic task with clinical and therapeutic implications. The underlying etiology is variable and includes degenerative, congenital, inflammatory, infectious, toxic, and traumatic causes. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. Due to their poorly elucidated underlying mechanisms, their variable presentations, and the lack of large scale outcome data on their various treatment modalities, coronary artery aneurysms and coronary ectasia pose a challenge to the managing clinician. Unlike aneurysms, ectasia is more frequently seen in association with atherosclerosis or as a compensatory mechanism in those cases in which a proximal stenosis is noted in the opposite coronary artery; ectasia is also seen in some coronary artery anomalies, such as anomalous origin from the pulmonary artery, or as a result of a high-flow state, as seen in coronary artery fistulas. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the. The diagnostic approach depends on the clinical scenario, and nowadays, noninvasive evaluation with multidetector computed tomography is possible. The purpose of this review is to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and to provide a succinct review of aneurysmal coronary disease, with a special emphasis on the challenges associated with its interventional treatment.