Coronary Artery Ectasia-A Review of Current Literature

Subodh Devabhaktuni, Ana Mercedes, Jimmy Diep, Chowdhury Ahsan, Subodh Devabhaktuni, Ana Mercedes, Jimmy Diep, Chowdhury Ahsan

Abstract

Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders. Its incidence ranges from 1.2%-4.9%. Coronary artery ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth with atherosclerosis being the most common cause. Although, it has been described more than five decades ago, its management is still debated. We therefore reviewed the literature until date by searching PubMed and Google scholar using key words "coronary artery ectasia", "coronary artery aneurysm", "pathophysiology", "diagnosis", "management" either by itself or in combination. We reviewed the full articles and review articles and focused mainly on pathophysiology, diagnosis and management of CAE.

Figures

Fig. (1)
Fig. (1)
Coronary angiogram showing ectasia of the left main coronary artery, left anterior descending artery, ramus intermedius, proximal left circumflex (a) and right coronary artery (b).
Fig. (2)
Fig. (2)
Pathogenesis of coronary artery ectasia. RAS-Renin Angiotensin system. A number of factors implicated in the atherosclerotic process promote the expression and activity of matrix degrading enzymes, which cause severe disruption in the internal elastic lamina (IEL) and provide a gateway for the inflammatory cells to extend into the media, favoring excessive expansive remodeling and ultimately leading to formation of coronary ectasia. Adapted with permission from A.P. Antoniadis et al. [6].
Fig. (3)
Fig. (3)
Histology of the left circumflex coronary artery aneurysm. A. Tunica intima expanded by atherosclerosis (left) and tunica media attenuated and densely infiltrated by inflammatory cells (right) (hematoxylin-eosin, original magnification x10). B. Higher power showing the inflammatory cells to be predominantly lymphocytes, with a few residual smooth muscle cells (bottom center) (hematoxylin-eosin, original magnification x20). Reproduced with permission from Nichols et al. [16].

References

    1. Swaye P.S., Fisher L.D., Litwin P., et al. Aneurysmal coronary artery disease. Circulation. 1983;67(1):134–138.
    1. Hartnell G.G., Parnell B.M., Pridie R.B. Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br. Heart J. 1985;54(4):392–395.
    1. Markis J.E., Joffe C.D., Cohn P.F., Feen D.J., Herman M.V., Gorlin R. Clinical significance of coronary arterial ectasia. Am. J. Cardiol. 1976;37(2):217–222.
    1. Harikrishnan S., Sunder K.R., Tharakan J., et al. Coronary artery ectasia: angiographic, clinical profile and follow-up. Indian Heart J. 2000;52(5):547–553.
    1. Gunes Y., Boztosun B., Yildiz A., et al. Clinical profile and outcome of coronary artery ectasia. Heart. 2006;92(8):1159–1160.
    1. Lam C.S., Ho K.T. Coronary artery ectasia: a ten-year experience in a tertiary hospital in Singapore. Ann. Acad. Med. Singapore. 2004;33(4):419–422.
    1. Almansori M.A., Elsayed H.A. Coronary artery ectasia – A sample from Saudi Arabia. J. Saudi Heart Assoc. 2015;27(3):160–163.
    1. Elahi M.M., Dhannapuneni R.V., Keal R. Giant left main coronary artery aneurysm with mitral regurgitation. Heart. 2004;90(12):1430.
    1. Roberts W.C. Natural history, clinical consequences, and morphologic features of coronary arterial aneurysms in adults. Am. J. Cardiol. 2011;108(6):814–821.
    1. Antoniadis A.P., Chatzizisis Y.S., Giannoglou G.D. Pathogenetic mechanisms of coronary ectasia. Int. J. Cardiol. 2008;130(3):335–343.
    1. Liu J., Sukhova G.K., Yang J-T., et al. Cathepsin L expression and regulation in human abdominal aortic aneurysm, atherosclerosis, and vascular cells. Atherosclerosis. 2006;184(2):302–311.
    1. Anderson P.W., Zhang X.Y., Tian J., et al. Insulin and angiotensin II are additive in stimulating TGF-beta 1 and matrix mRNAs in mesangial cells. Kidney Int. 1996;50(3):745–753.
    1. Kol A., Sukhova G.K., Lichtman A.H., Libby P. Chlamydial heat shock protein 60 localizes in human atheroma and regulates macrophage tumor necrosis factor-alpha and matrix metalloproteinase expression. Circulation. 1998;98(4):300–307.
    1. Johanning J.M., Franklin D.P., Han D.C., Carey D.J., Elmore J.R. Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion. J. Vasc. Surg. 2001;33(3):579–586.
    1. Giannoglou G.D., Soulis J.V., Farmakis T.M., Farmakis D.M., Louridas G.E. Haemodynamic factors and the important role of local low static pressure in coronary wall thickening. Int. J. Cardiol. 2002;86(1):27–40.
    1. Nichols L., Lagana S., Parwani A. Coronary artery aneurysm: a review and hypothesis regarding etiology. Arch. Pathol. Lab. Med. 2008;132(5):823–828.
    1. Gülec S., Aras Ö., Atmaca Y., et al. Deletion polymorphism of the angiotensin I converting enzyme gene is a potent risk factor for coronary artery ectasia. Heart. 2003;89(2):213–214.
    1. Lamblin N., Bauters C., Hermant X., Lablanche J-M., Helbecque N., Amouyel P. Polymorphisms in the promoter regions of MMP-2, MMP-3, MMP-9 and MMP-12 genes as determinants of aneurysmal coronary artery disease. J. Am. Coll. Cardiol. 2002;40(1):43–48.
    1. Sudhir K., Ports T.A., Amidon T.M., et al. Increased Prevalence of Coronary Ectasia in Heterozygous Familial Hypercholesterolemia. Circulation. 1995;91(5):1375–1380.
    1. Baugh M.D., Gavrilovic J., Davies I.R., Hughes D.A., Sampson M.J. Monocyte matrix metalloproteinase production in Type 2 diabetes and controls--a cross sectional study. Cardiovasc. Diabetol. 2003;2:3.
    1. Kornowski R., Mintz G.S., Lansky A.J., et al. Paradoxic decreases in atherosclerotic plaque mass in insulin-treated diabetic patients. Am. J. Cardiol. 1998;81(11):1298–1304.
    1. Satran A., Bart B.A., Henry C.R., et al. Increased prevalence of coronary artery aneurysms among cocaine users. Circulation. 2005;111(19):2424–2429.
    1. Aboeata A.S., Sontineni S.P., Alla V.M., Esterbrooks D.J. Coronary artery ectasia: current concepts and interventions. Front. Biosci. (Elite Ed.) 2012;4:300–310.
    1. Sayin T., Döven O., Berkalp B., Akyürek O., Güleç S., Oral D. Exercise-induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease. Int. J. Cardiol. 2001;78(2):143–149.
    1. Saglam M., Karakaya O., Barutcu I., et al. Identifying cardiovascular risk factors in a patient population with coronary artery ectasia. Angiology. 2007;58(6):698–703.
    1. Altinbas A., Nazli C., Kinay O., et al. Predictors of exercise induced myocardial ischemia in patients with isolated coronary artery ectasia. Int. J. Cardiovasc. Imaging. 2004;20(1):3–17.
    1. Mrdović I., Jozić T., Asanin M., Perunicić J., Ostojić M. Myocardial reinfarction in a patient with coronary ectasia. Cardiology. 2004;102(1):32–34.
    1. Kühl M., Varma C. A case of acute coronary thrombosis in diffuse coronary artery ectasia. J. Invasive Cardiol. 2008;20(1):E23–E25.
    1. Rath S., Har-Zahav Y., Battler A., et al. Fate of nonobstructive aneurysmatic coronary artery disease: angiographic and clinical follow-up report. Am. Heart J. 1985;109(4):785–791.
    1. Akyürek O., Berkalp B., Sayin T., Kumbasar D., Kervancioğlu C., Oral D. Altered coronary flow properties in diffuse coronary artery ectasia. Am. Heart J. 2003;145(1):66–72.
    1. Pahlavan P.S., Niroomand F. Coronary artery aneurysm: a review. Clin. Cardiol. 2006;29(10):439–443.
    1. Kim W.Y., Danias P.G., Stuber M., et al. Coronary magnetic resonance angiography for the detection of coronary stenoses. N. Engl. J. Med. 2001;345(26):1863–1869.
    1. Mavrogeni S., Markousis-Mavrogenis G., Kolovou G. Contribution of cardiovascular magnetic resonance in the evaluation of coronary arteries. World J. Cardiol. 2014;6(10):1060–1066.
    1. Díaz-Zamudio M., Bacilio-Pérez U., Herrera-Zarza M.C., et al. Coronary Artery Aneurysms and Ectasia: Role of Coronary CT Angiography. Radiographics. 2009;29(7):1939–1954.
    1. Sanidas E.A., Vavuranakis M., Papaioannou T.G., et al. Study of atheromatous plaque using intravascular ultrasound. Hell J Cardiol HJC Hellēnikē Kardiologikē Epitheōrēsē. 2008;49(6):415–421.
    1. al-Harthi S.S., Nouh M.S., Arafa M., al-Nozha M. Aneurysmal dilatation of the coronary arteries: diagnostic patterns and clinical significance. Int. J. Cardiol. 1991;30(2):191–194.
    1. Yasar A.S., Erbay A.R., Ayaz S., et al. Increased platelet activity in patients with isolated coronary artery ectasia. Coron. Artery Dis. 2007;18(6):451–454.
    1. Sorrell V.L., Davis M.J., Bove A.A. Current knowledge and significance of coronary artery ectasia: a chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations. Clin. Cardiol. 1998;21(3):157–160.
    1. Demopoulos V.P., Olympios C.D., Fakiolas C.N., et al. The natural history of aneurysmal coronary artery disease. Heart. 1997;78(2):136–141.
    1. Tengiz I., Ercan E., Aliyev E., Sekuri C., Duman C., Altuglu I. Elevated levels of matrix metalloprotein-3 in patients with coronary aneurysm: A case control study. Curr. Control. Trials Cardiovasc. Med. 2004;5(1):10.
    1. Krüger D., Stierle U., Herrmann G., Simon R., Sheikhzadeh A. Exercise-induced myocardial ischemia in isolated coronary artery ectasias and aneurysms (“dilated coronopathy”). J. Am. Coll. Cardiol. 1999;34(5):1461–1470.
    1. Fineschi M., Gori T., Sinicropi G., Bravi A. Polytetrafluoroethylene (PTFE) covered stents for the treatment of coronary artery aneurysms. Heart. 2004;90(5):490.
    1. Badmanaban B., Mallon P., Campbell N., Sarsam M.A. Repair of left coronary artery aneurysm, recurrent ascending aortic aneurysm, and mitral valve prolapse 19 years after Bentall’s procedure in a patient with Marfan syndrome. J. Card. Surg. 2004;19(1):59–61.
    1. Harandi S., Johnston S.B., Wood R.E., Roberts W.C. Operative therapy of coronary arterial aneurysm. Am. J. Cardiol. 1999;83(8):1290–1293.
    1. Befeler B., Aranda M.J., Embi A., Mullin F.L., El-Sherif N., Lazzara R. Coronary artery aneurysms: study of the etiology, clinical course and effect on left ventricular function and prognosis. Am. J. Med. 1977;62(4):597–607.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅