Current knowledge and significance of coronary artery ectasia: A chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations

Abstract

Summary:Coronary artery ectasia is the abnormal enlargement of the coronary artery. The prognosis, treatment, and etiology of this disease remain an enigma. There is some evidence to suggest that the incidence of ectasia is increasing, and therefore understanding of this entity needs to improve. This article reviews the current literature on coronary artery ectasia and summarizes the findings. A treatment plan that targets each of the suggested clinical complications is provided. Using multiple indirect observations and current understanding of endothelium-derived relaxation factor, a possible etiology that implicates overstimulation of endogenous nitric oxide is provided. Current literature suggests that ectatic coronary arteries, even without the presence of coronary stenosis, are subject to thrombus formation, vasospasm, and spontaneous dissection. Newer subgroups of ectasia are arising with the use of multiple interventional devices to dilate coronary artery stenosis. By design, these destroy the media of the coronary artery, and it is not clear whether these "iatrogenic" ectatic arteries are subject to the same complications as "idiopathic" coronary artery ectasia. Further investigation is necessary to help define the benefit of the proposed treatment regimen, to clarify the prognosis of these newer groups of "iatrogenic" ectasia, and to confirm or disprove the hypothesis targeting nitric oxide as an etiologic factor.This manuscript was published in part as a "signed commentary" in the January 20, 1996 issue of The Lancer. ReviewThe first case report of a coronary artery aneurysm was by Bourgon ( 1 8 12) who described the postmortem finding of a right coronary artery dilatation in a patient who died suddenly.' The first literature review was provided by Packard and Wechsler and included 20 additional case reports and patient profiles? The first use of the term "ectasia" to describe dilated coronary arteries in vivo was provided by B j~r k .~ He included three patients who underwent angiography for cyanosis. At cardiac catheterization, they were found to have tetrology of Fallot and also markedly dilated coronary arteries. Surgical repair of the tetrology was performed without complication. The surgeon dealt with the dilated coronary arteries simply by manually pushing the ectatic vessels aside at the time of surgery. No etiology for the never before described anomaly was offered and no follow-up was provided.Markis et al. provided the first prospective evaluation of the incidence of coronary artery ectasia." They found 30 patients in a study group consisting of 2,500 consecutive cardiac catheterizations. Their work provided insight into the incidence, associated factors, and clinical outcome over a shortterm follow-up of 24 months. Markis et al. found that patients without coronary artery disease, but with ectasia, had a greater prevalence of family histories with coronary artery disease, abnormal electrocardiograms, previous myocardial infarctions, and hypertension than the control group. They also found ...

Two Locations, Two Hits; Two Faces of The Sword: Co-Existence of Coronary and Cerebral Arterial Aneurysms

“…Coronary ectasia is defined as a ≥1.5-fold diffuse or localized luminal dilatation of the coronary artery compared to the diameter of normal segments (1,2). CA detected in 0.3%-5.3% of consecutive angiographic studies (3,4).…”

Aneurysm of the left main coronary artery

“…Evidence, however, exists that suggests that the incidence of ectasia in coronary arteries is increasing. Its etiology, treatment, and prognosis remain obscure, and knowledge about this entity should be improved 9 . Potential causes of the formation of aneurysms in coronary arteries are cited in Table I.…”

“…Sorrell et al 9 suggest an association between the chronic stimulation of endogenous nitric oxide, with consequent chronic stimulation of vascular relaxation, and the occurrence of areas of ectasia in coronary arteries.…”

Comparison of outcomes of diseased coronary arteries ectasia, stenosis and combined

“…Different possible etiologies are proposed for CAE, including atherosclerosis, Kawasaki disease, Takayasu, congenital disorders, post-stenting (iatrogenic), polyarteritis nodosa, syphilis, polycystic kidney disease, and familial homozygous hypercholesterolemia (4)(5)(6). Higher levels of local metalloproteinase and plasma soluble adhesion molecules such as ICAM-1, VCAM-1, and E-selectin are also observed in CAE patients (7,8).…”