Coronary Artery Aneurysmal Disease and Acute Coronary Syndrome
Wesam Ostwani1, Holly Fleming2, Carlos A Roldan2
1University of New Mexico, Albuquerque, NM, USA.
Insights
This case study highlights successful conservative treatment for coronary artery aneurysmal disease (CAAD) presenting as acute coronary syndrome (ACS). It details a unique presentation of multi-vessel CAAD with dissection and sluggish flow, managed medically.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery aneurysmal disease (CAAD) affects 1.5-4.9% of adults, often stemming from atherosclerosis.
- Management guidelines for CAAD complicated by acute coronary syndrome (ACS) are lacking, with ongoing debate on optimal treatment strategies.
- This case presents a 70-year-old male with no traditional risk factors experiencing ACS, specifically unstable angina progressing to non-ST elevation myocardial infarction (NSTEMI).
Purpose of the Study:
- To describe a unique case of multi-vessel coronary artery aneurysmal disease with dissection and sluggish flow.
- To report the successful conservative medical management of coronary artery aneurysmal disease complicated by acute coronary syndrome.
- To contribute to the understanding of managing complex coronary artery aneurysmal disease presentations.
Main Methods:
- Diagnostic cardiac catheterization to assess coronary anatomy and flow.
- Identification of nonobstructive 3-vessel multi-aneurysmal coronary artery disease.
- Conservative medical therapy initiated for the management of coronary artery aneurysmal disease and acute coronary syndrome.
Main Results:
- Cardiac catheterization revealed nonobstructive 3-vessel coronary artery aneurysms with reduced antegrade flow.
- A nonobstructive aneurysmal dissection flap was identified in the left anterior descending artery, potentially causing thrombosis and microembolization.
- The patient demonstrated a positive clinical response to conservative medical management, indicating successful treatment without invasive or surgical intervention.
Conclusions:
- Conservative medical therapy can be a viable and successful approach for managing coronary artery aneurysmal disease presenting with acute coronary syndrome.
- This case underscores the importance of considering non-atherosclerotic etiologies and unique anatomical findings in acute coronary syndromes.
- Further research is warranted to establish evidence-based guidelines for the management of coronary artery aneurysmal disease complicated by ACS.
Abstract:
The patient is a 70-year-old male with no other atherogenic risk factors who presented with an acute coronary syndrome (ACS) of unstable angina subsequently complicated by a non-ST elevation myocardial infarction (NSTEMI). The patient's presentation posed 3 unique features: (1) cardiac catheterization demonstrated nonobstructive 3-vessel multi-aneurysmal coronary artery disease with sluggish antegrade coronary flow; (2) a nonobstructive aneurysmal dissection flap based on contrast staining of the mid left anterior descending artery, which may have led to in situ nonocclusive thrombosis and distal microvascular embolization; and (3) successful conservative medical therapy of coronary artery aneurysmal disease (CAAD) complicated with ACS. CAAD has an incidence of 1.5% to 4.9% in adults. The most common etiology of CAAD is atherosclerotic coronary artery disease. There are no guidelines for the management of CAAD complicated by ACS, and controversies exist as to whether conservative, catheter-based, or surgical management should be pursued.
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