Natural history, clinical consequences, and morphologic features of coronary arterial aneurysms in adults

Area of Science:

• Cardiovascular Pathology
• Atherosclerosis Research

Background:

• Coronary artery aneurysms (CAAs) are rare vascular abnormalities.
• Their pathogenesis, particularly the role of atherosclerosis, requires further elucidation.
• Clinical diagnosis and therapeutic strategies for CAAs remain challenging.

Purpose of the Study:

• To describe the clinical and morphologic features of coronary artery aneurysms identified at necropsy.
• To investigate the association between intra-aneurysmal thrombi, atherosclerosis, and aneurysm etiology.
• To evaluate the clinical impact of CAAs on myocardial tissue.

Main Methods:

• Retrospective analysis of necropsy findings in 20 adult patients with coronary artery aneurysms.
• Morphologic examination of 34 coronary aneurysms for thrombi and atherosclerotic plaque.
• Correlation of aneurysm characteristics with patient demographics and clinical history.

Main Results:

• Twenty adults (mean age 56 years) had 34 coronary aneurysms; 79% contained thrombi severely narrowing the lumen.
• Atherosclerotic plaque was present in aneurysmal walls with thrombi, suggesting an atherosclerotic etiology in 16 patients.
• Congenital etiology was considered in 4 patients with 7 aneurysms lacking thrombi or plaque.
• Despite aneurysms and luminal narrowing, only 40% showed signs of myocardial ischemia or infarction.
• No patient received a clinical diagnosis of coronary aneurysm during life due to lack of appropriate imaging.

Conclusions:

• Coronary artery aneurysms are frequently associated with intra-aneurysmal thrombi and atherosclerosis.
• Atherosclerosis is a likely cause of many CAAs, while a congenital origin exists for others.
• The clinical presentation and consequences of CAAs may be less severe than anticipated, but therapeutic approaches are not well-defined.