Ectatic Coronary Arteries Research Articles

A case of successful reperfusion through a combination of intracoronary thrombolysis and aspiration thrombectomy in ST-segment elevation myocardial infarction associated with an ectatic coronary artery

BackgroundLarge thrombus burdens in ectatic coronary arteries that remain after aspiration thrombectomy can negatively impact outcomes following percutaneous coronary interventions in patients with acute myocardial infarction.Case presentationA 53-year-old man presented with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed an ectatic right coronary artery (RCA) that was completely occluded in the mid portion by a large amount of thrombus. Catheter-directed intracoronary thrombolysis with alteplase led to recovery of coronary blood flow, which multiple attempts of aspiration thrombectomy had failed to achieve. Coronary angiography 9 days later showed good blood flow and insignificant stenosis remaining in the RCA; this had completely resolved in 6 months’ follow-up coronary angiography.ConclusionCatheter-directed intracoronary thrombolysis can be performed effectively and safely when repeat aspiration thrombectomy fails to produce satisfactory coronary reperfusion in STEMI patients with large thrombus burdens in ectatic coronary arteries.

Primary Angioplasty Using a Renal Stent in a Severly Ectactic and Occluded Left Anterior Descending Coronary Artery

Revascularization of ectatic coronary arteries in the setting of acute myocardial infarction pos- es great challenges for the operator. We report a case, where a peripheral renal stent was used successfully to treat the clinical situation.

Plasma thiols and thiol-disulfide homeostasis in patients with isolated coronary artery ectasia

Background and aimsThiol/disulfide homeostasis has an important role in the antioxidant defense system. Oxidative stress may contribute to the pathogenesis of coronary artery ectasia. The aim of this study was to evaluate plasma thiol levels and thiol/disulfide homeostasis in patients with isolated coronary artery ectasia. MethodsForty-one patients with isolated coronary artery ectasia and 72 patients with normal coronary arteries were included in the study. Markis classification and number of ectatic coronary arteries were recorded. Plasma total thiol levels, native thiol levels and disulfide levels were measured. Thiol/disulfide homeostasis was appraised by calculating thiol/disulfide ratio. ResultsPlasma native thiol levels were significantly lower (336.9 (252.9–374.1) vs. 353.1 (327.0–380.0), p = 0.041) and disulfide levels were significantly higher (18.9 ± 6.3 vs. 16.6 ± 3.4, p = 0.014) in patients with coronary artery ectasia than control patients. Both native thiol/disulfide and total thiol/disulfide ratio was significantly lower in the coronary artery ectasia group (p < 0.001). Multivariate logistic regression analysis revealed that native thiol levels, disulfide levels and native thiol/disulfide ratio were independently associated with the presence of coronary artery ectasia. Thiol/disulfide ratio was not different according to number of ectatic coronary arteries and there was no association between thiol/disulfide ratio and Markis classification. ConclusionsPlasma thiol/disulfide homeostasis is altered in patients with coronary artery ectasia.

Management of coronary artery aneurysms using abciximab in children with Kawasaki disease

IntroductionThere are limited data regarding the possible benefits of abciximab in children with Kawasaki disease (KD), who developed serious cardiac abnormalities non-responsive to standard treatment. Materials and methodsWe retrospectively identified children with KD who were treated with abciximab from 2007 to 2015. Data regarding clinical course, treatment, echocardiographic data and follow-up at 1 and 6months were retrieved. ResultsDuring the study period, fifteen children were identified who were diagnosed with KD and were given abciximab. The median age at onset of symptoms was 11months (range: 2months–6years). The median day of disease at admission was 10days (range: 4–26days) and the median day of administration of abciximab was 17days (range: 9–40). Twelve children were diagnosed with complete and three with incomplete KD. Aneurysms were found in 8 children: 2 had ectatic coronary arteries and 5 presented with both ectasia and aneurysms. At 1month follow-up, echocardiographic findings showed regression in the size of aneurysms in 11 children, resolution of the aneurysms or ectasia of coronary arteries in 3 children, while one child who could not take aspirin because of G6PD deficiency died. After 6months of follow-up, echocardiographic findings showed resolution of coronary abnormalities in 12 (80%) children, whereas 2 children (13.3%) presented with significant regression of aneurysms. ConclusionsAbciximab may have an important role in the management of severe cardiac complications of KD, although prospective randomized controlled studies are needed to fully evaluate its role.

Coronary flow improvement following unsuccessful primary percutaneous coronary intervention in ST-elevation myocardial infarction with diffuse ectatic coronary artery.

In ST-elevation myocardial infarction (STEMI) patients with diffuse ectatic coronary artery, extensive thrombi inhibit achievement of final successful revascularization of Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow after primary percutaneous coronary intervention. However, clinical and angiographic outcomes of such patients are uncertain. The present study examined clinical and angiographic outcomes in STEMI incorporating giant coronary artery with diffuse ectasia. Seven hundred and forty-four STEMI patients undergoing primary percutaneous coronary intervention were surveyed retrospectively. Culprit lesions in giant coronary artery with diffuse ectasia (Ectatic group, n=39) were investigated. Percutaneous coronary intervention success rate and angiographic or clinical outcomes at 360 days were compared with those of the Non-ectatic group ( n=705). Angiographic percutaneous coronary intervention success rate was significantly lower in the Ectatic group due to lower achievement of final TIMI grade 3 flow (53.8% vs. 92.9%, p<0.0001; 53.8% vs. 93.5%, p<0.0001, respectively). In follow-up angiography, 86% of the Ectatic group showed angiographic improvement from TIMI grade 2 or less immediately after percutaneous coronary intervention to TIMI grade 3 flow at follow-up. In contrast, angiographic improvement was observed in only 25% of cases in the Non-ectatic group. All-cause 360-day mortality was significantly lower in the ectatic group (2.6% vs. 14.5%, p=0.0361, respectively). In patients with STEMI in giant coronary artery with diffuse ectasia, achievement of TIMI grade 3 flow was significantly reduced immediately after percutaneous coronary intervention. However, improvement of coronary flow up to TIMI grade 3 was not uncommon at follow-up angiogram. Patients had low mortality despite low TIMI grade 3 achievement immediately after primary percutaneous coronary intervention.

Severely ectatic left circumflex coronary artery presenting with an ST-elevation myocardial infarction: A case report

Severely ectatic left circumflex coronary artery presenting with an ST-elevation myocardial infarction: A case report

Effect of Diltiazem on Coronary Artery Flow and Myocardial Perfusion in Patients With Isolated Coronary Artery Ectasia and Either Stable Angina Pectoris or Positive Myocardial Ischemic Stress Test

Isolated coronary artery ectasia (CAE) may be associated with stable or unstable coronary events despite the absence of epicardial coronary stenosis. Impaired coronary flow dynamics and myocardial perfusion have been demonstrated in stable patients with ectatic coronary arteries. We aimed to assess whether epicardial flow and tissue-level perfusion would be improved by diltiazem in myocardial regions subtended by the ectatic coronary arteries in patients with isolated CAE. A total of 60 patients with isolated CAE were identified of 9,780 patients who underwent elective coronary angiography. Patients were randomized to 5mg of intracoronary diltiazem or saline. Coronary blood flow of the microvascular network was assessed using myocardial blush grade (MBG) technique. The thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (TFC) were used to assess epicardial coronary flow. MBG (from 2.4 to 2.6, p= 0.02), TIMI flow grades (from 2.4 to 2.8, p <0.001), and TFC (from 35 to 26, p <0.001) were significantly improved after diltiazem, whereas no significant change was noticed after saline (from 2.4 to 2.4, p= 0.86 for MBG; from 2.3 to 2.3, p= 0.71 for TIMI flow grade; and from 35 to 33, p= 0.43 for TFC). Diltiazem provided amelioration of the altered coronary flow dynamics, which was suggested as the pathophysiological influence of CAE. In conclusion, the favorable effects of the diltiazem on myocardial perfusion were observed at both epicardial and tissue levels.

Double Balloon Angioplasty in a Patient with Right Coronary Artery Ectasia

Abstract: There is no current guideline for percutaneous coronary angioplasty in stenotic ectatic coronary arteries due to variations in coronary anatomy. We report successful simultaneous double balloon angioplasty in a patient who had coronary artery ectasia

Transradial percutaneous coronary intervention with Stentys self-apposing stents and Stentys–Yew technique for angulated and ectatic coronary artery

Transradial percutaneous coronary intervention with Stentys self-apposing stents and Stentys–Yew technique for angulated and ectatic coronary artery

Early experience of transradial multivessel percutaneous coronary intervention with new generation STENTYS sirolimus eluting self-apposing stents for ectatic coronary arteries

Early experience of transradial multivessel percutaneous coronary intervention with new generation STENTYS sirolimus eluting self-apposing stents for ectatic coronary arteries

PP-024 Successful Trapping of a Warm-like Thrombus in an Ectatic Right Coronary Artery Causing Acute Myocardial Infarction

A 53-year-old male non-smoker with hypertension and hypercholesterolemia (LDL:215MG/DL) presented 2 hours after sudden onset of severe chest pain with persistent angina and ST elevations in the inferior leads. He received electroshocks because of ventricular fibrilation in the emergency department. Emergent coronary angiography showed right coronary artery (RCA) occlusion distal to a fusiform aneurysm of the proximal RCA and an occlusion of the vessel downstream due to a huge organized thrombus. There were also aneurysmatic and ectatic segments in the mid portion of left anterior descending and distal left circumflex arteries. An aspiration catheter was advanced to the RCA to aspirate the thrombus over an intermediate guidewire. A huge warm-like (>3cm) red thrombus was retrived from the guiding catheter by applying negative pressure. After the successful thrombectomy, TIMI 3 coronary flow was restored and ST elevation and chest pain of the patient resolved. Glycoprotein IIb/IIIa antagonist was administered during and 48 hours after the procedure along with unfractioned heparin, clopidogrel and ASA. The postoperative course was uneventful and the left ventricular ejection fraction was within the normal range without any wall motion abnormality.

Abstract 19274: Coronary Artery Ectasia Are Frequently Observed in Patients With Bicuspid Aortic Valves With and Without Aneurysm of the Ascending Aorta

Background: The exact etiology and prognostic significance of coronary artery ectasia (CAE) is still unknown. The presence of CAE is influenced by genetic factors and related to the presence of aneurysms in other vascular beds. Bicuspid aortic valve (BAV) disease is frequently accompanied by ascending aortic aneurysm. Since the aortic valve, the ascending aorta, and the proximal parts of the coronary arteries share a common embryonic origin, we hypothesized that CAE is associated with BAV disease. Methods: 181 patients with suspected aortic valve disease (n=101 BAV) underwent both cardiac magnetic resonance (CMR) imaging and coronary angiography. Eighty subjects with tricuspid aortic valve (TAV) disease were similarly studied and served as controls. The readers of the angiograms were blinded to valve type and clinical data. In order to confirm the association of CAE with BAV, the frequency of CAE was evaluated in an in-house BAV registry (n=500) and compared to the frequency of CAE in the German MI family study, in which the heritability of CAE was formerly established (899 with available coronary angiograms), as well as in an observational registry of “real-life patients” undergoing coronary angiography for clinically indicated reasons (n=3471). Furthermore the frequency of CAE was investigated in a subgroup of the KORA MI study, which is a population-based registry that comprises all hospitalized cases of acute non-fatal MI and coronary deaths occurring in inhabitants of a defined study region (n=403). Results: Compared to TAV disease, CAE occured twice as frequently in CMR confirmed BAV disease, (17.5% vs. 41.6%, p=0.0005). Ascending aortic aneurysm or ectasia was diagnosed in 60 subjects with BAV disease (59.4%), but CAE occurred similarly between subjects with (59.5%) and without (40.5%) ascending aortic pathology. The common appearance of CAE in patients with BAV could be independently confirmed in the BAV registry (38.9%), whereas CAE was found less frequently in family history positive MI patients (21.2%), and rarely in unrelated “real-life” catheterization patients (5.2%). Conclusion: To our knowledge, our data show for the first time that ectatic coronary artery disease is a common appearance of BAV disease with and without ascending aortic aneurysm.

DEFERRED STENTING - AN ALTERNATIVE STRATEGY FOR THE INVASIVE MANAGEMENT OF STEMI PATIENTS WITH SIGNIFICANT THROMBUS BURDEN

myocardial infarction (STEMI). Despite this, there is a lack of data in this high-risk patient population. The purpose of the study is to characterize the baseline characteristics, culprit lesions and outcomes of patients with previous CABG and STEMI. METHODS AND RESULTS: We retrospectively reviewed a database of all patients undergoing emergency percutaneous coronary intervention (PCI) of which 95.8% of patients had electrocardiographic evidence of STEMI at a single-centre in British Columbia between January 2009 and December 2013. There were 94 (2.9%) patients with a prior history of CABG in a total of 3231 patients. The prior CABG group was significantly older and had a significantly greater incidence of hypertension, dyslipidemia, diabetes, previousMI, previous heart failure, and previous PCI. There was a significantly greater length of stay in the CABG population, but no difference when comparing in hospital mortality. The infarct-related vessel in the CABG group was a bypass graft in 44 patients (48.9%), native coronary artery in 36 patients (40.0%), was not identifiable in 10 patients (11.1%) and 4 patients had missing data. We further stratified previous CABG patients by the time between emergency PCI and index CABG. There were 79 patients (84.0%) who had CABG more than five years from emergency PCI. There were no significant differences in baseline characteristics, culprit lesions and 30-day mortality between CABG more than five years and less than five years from emergency PCI. CONCLUSION: Emergency PCI for STEMI after previous CABG is associated with more comorbidities when compared with patients that did not undergo previous CABG. However, there were similar outcomes in short-term mortality. Furthermore, there were no significant differences in baseline characteristics and short-term mortality between the timing from initial CABG to emergency PCI. Further data analysis is needed to characterize longer-term outcomes.

Combined intracoronary thrombolysis, thrombus aspiration and mesh-covered stent implantation for organized massive thrombus burden in ectatic coronary

Organized intracoronary thrombus is associated with adverse outcomes due to distal embolization and no-reflow phenomenon during PCI, particularly in large or ectatic coronary arteries. Intracoronary thrombolysis is an underused but effective and safe strategy. We describe the case of a 56-year-old man admitted due to a subacute myocardial infarction with massive thrombus burden in a right ectatic coronary artery to present the usefulness of a sequential approach with intracoronary thrombolysis, thrombus aspiration and a novel mesh-covered stent implantation as a reasonable and effective strategy to avoid a no-reflow phenomenon during PCI, achieving an immediate successful angiographic result, and a positive long-term clinical outcome.

Severely ectatic left circumflex coronary artery with fistula to coronary sinus presenting with acute coronary syndrome

Introduction: coronary artery fistulas are uncommon anomalies. they occur in 0.1–0.8% of patients undergoing coronary arteriography. the circumflex coronary arteriovenous fistulae (cAF) associated with aneurysmal dilatation and drainage into coronary sinus (cs) are even less common. We present a case of a 56-yearold male with an acute coronary syndrome who was found to have a tortuous and aneurysmal circumflex coronary artery terminating into the cs. case report: A previously healthy 56-yearold male developed acute retrosternal chest pain while skiing. Physical examination revealed a grade II/VI continuous murmur at the left lower sternal border, but was otherwise unremarkable. Laboratory investigations revealed an elevated troponin and st depression in the inferior leads on his electrocardiography. coronary angiography showed a diffusely aneurysmal circumflex artery with a fistula to the cs. the patient underwent successful surgical ligation of the fistula. conclusion: Our patient presented with an acute coronary syndrome caused by an uncommon form of coronary artery fistula. conventional coronary angiography failed to fully define the anatomy of the fistula (origin, pathway, and outflow). Multidetector computed tomography was complementary to demonstrate the complex anatomy of the fistula. the fistula was surgically ligated and he remains well.

Left main coronary artery aneurysm

Left main coronary artery aneurysms (LMCA) are usually asymptomatic and are rarely encountered during coronary angiography. The most serious complications include coronary thrombosis, acute myocardial infarction and sudden death. Atherosclerosis is the most common cause, although several autoimmune diseases and congenital abnormalities have been associated with the presence of coronary aneurysms. The case of a symptom-free 63-year-old man with a giant LMCA and severely ectatic coronary arteries is presented.

Two Different Successful Angioplasty Methods in Patients with Stenotic Coronary Artery Ectasia

There is no current guideline for percutaneous coronary angioplasty in stenotic ectatic coronary arteries because of the heterogeneity of the coronary artery morphology. We report two successful angioplasty cases in coronary artery ectasia with different clinical scenarios. One case showed atherosclerotic stenosis in the ectatic portion of the right coronary artery that was aggravated after a coronary artery bypass graft. In this case, balloon angioplasty alone without stenting showed acceptable results at the 6-month follow-up coronary angiography. In the other case, we used a peripheral artery balloon and stent for stenosis in the ectatic portion of a large coronary artery. Six-month follow-up coronary angiography showed excellent patency of the previously implanted peripheral stent.

Neutrophil Gelatinase-Associated Lipocalin Levels in Isolated Coronary Artery Ectasia

Background The pathophysiology of coronary artery ectasia (CAE) is still unknown. Inflammation and degradation of connective tissue may have a role in the development of coronary ectasia. In the present study, the authors examined neutrophil gelatinase-associated lipocalin (NGAL) levels in isolated CAE patients. Methods Thirty-five patients with isolated CAE (25 males; mean age, 59 ± 10 years) and 35 age- and sex-matched healty volunteers (22 males; mean age, 57 ± 11 years) who had been shown to have normal coronary arteries were included in the study. Basal characteristics were recorded. Serum NGAL levels were determined with an enzyme-linked immunosorbent assay kit. Results NGAL levels were significantly higher in the isolated CAE group than in the control group (65.1 ± 13 vs 53.7 ± 19 ng/mL; P = 0.006). There were also significant difference in NGAL levels according to the number of ectatic coronary arteries (58.1 ± 13, 70.9 ± 9, and 71.1 ± 11 ng/mL for 1, 2, and 3 arteries, respectively; P = 0.015). Level of NGAL was lowest in patients who have only 1 ectatic coronary artery. Conclusion Serum NGAL levels increased in patients with isolated CAE, and NGAL may play a crucial role in the development and/or progression of coronary artery ectasia.

Coronary artery ectasia in a patient with polycystic kidney disease.

A 44 years old male patient with acute coronary syndrome and polycystic kidney disease is described. Coronary angiography showed ectatic coronary arteries. Polycystic kidney disease is the most common inherited kidney disorder which is commonly associated with extra renal manifestations including cardiovascular conditions. Involvement of vessels may lead to arterial aneurysms which most commonly present as intracranial aneurysms. The rare association between coronary aneurysms and polycystic kidney disease has also been noted.

Coronary Artery Abnormalities in CREST Syndrome Revealed by Cardiovascular Magnetic Resonance Imaging

CREST syndrome represents a subset of systemic sclerosis (SSc). Five patients with CREST syndrome and 5 with SSc without cardiac symptoms and with normal routine cardiac examination were investigated by cardiovascular magnetic resonance. All CREST patients had ectatic coronary arteries, and in 1 of them, an inferior, transmural myocardial infarction was identified. Furthermore, patchy fibrosis was identified in all the patients with SSc, although their coronary arteries were normal. Cardiovascular magnetic resonance can be a useful, noninvasive diagnostic tool in the evaluation of asymptomatic CREST and SSc patients.