What is the plausible strategy for the management of patients with isolated coronary artery ectasia and myocardial ischemia?

Turhan, Hasan; Yetkın, Ertan

doi:10.1016/j.ijcard.2006.05.042

Cited by 7 publications

(6 citation statements)

References 7 publications

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“…This is very intriguing because the destruction of the musculoelastic component of the vascular media is assumed to be irreversible. Single-antiplatelet therapy may be warranted for primary prevention of cardiovascular events in isolated CAE [52,65,69,70]. Addition of lifetime systemic anticoagulation therapy may be recommended for secondary, but not primary prevention [2,52,65,71].…”

Section: Managementmentioning

confidence: 99%

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Dahhan

2015

Cardiovascular Therapeutics

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SUMMARYCoronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, b-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.

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Section: Managementmentioning

confidence: 99%

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Dahhan

2015

Cardiovascular Therapeutics

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“…Unlike the concomitant CAD and CAE, medical treatment for isolated CAE is not readily described. Since patients with isolated CAE or dilated coronaropathy have considerable risk of myocardial infarction due to microemboli and thrombotic occlusion [ 65 ], the application of platelet inhibitors as prophylaxis against ischemic syndromes is indispensable in all forms of CEA [ 48 , 89 ]. Although some authors previously suggested use of anticoagulant drugs in patients with CAE, there is no available data to date [ 52 ].…”

Section: Clinical Course and Treatment Of Caementioning

confidence: 99%

Novel insights into an old controversy

Yetkın

Waltenberger

2007

Clin Res Cardiol

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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.

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“…There are no an effective treatment for CAA, and further studies are needed to establish a guideline. Due to the risk of thrombosis associated with CAA, platelet inhibitors are used to prevent ischemic synthesis caused by brin thrombosis and microemboli, so antiplatelet and/or anticoagulation therapy were recommended [5,18] . Surgical treatment was an option to avoid CAA rupture, dissection, myocardial ischemia and embolism [2,19,20] , although their speci c surgical treatment standards have not yet reached consensus [1] .…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Coronary Artery Aneurysm with Calcification and Stenosis: A Case Report and Review of the Literature

Sun

Zhang

et al. 2020

Preprint

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Coronary artery aneurysm (CAA) has been increasingly reported in recent years. The symptoms are related to myocardial ischemia, such as angina pectoris, myocardial infarction, sudden death and congestive heart failure. This report describes a case of a giant CAA with calcification and stenosis involving two coronary arteries, and the patient underwent a complete arterialized coronary artery bypass graft. After 3 months of follow-up, it was found that the radial artery graft was occluded. In this report, all cases related to CAA with calcification and stenosis are summarized. According to the data, the following conclusions can be drawn: CAA seem to be more common in men; Kawasaki disease is likely to be a causative factor in some patients with asymptomatic CAA involving calcification and stenosis; CABG is a feasible treatment option for CAA with calcification and stenosis.

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What is the plausible strategy for the management of patients with isolated coronary artery ectasia and myocardial ischemia?

Cited by 7 publications

References 7 publications

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

Novel insights into an old controversy

Surgical Treatment of Coronary Artery Aneurysm with Calcification and Stenosis: A Case Report and Review of the Literature

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