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Aneurysmal coronary artery disease: An overview
Mohamed S ElGuindy1, Ahmed M ElGuindy2,3
1Department of Cardiology, Cairo University, Egypt.
Insights
Aneurysmal coronary artery disease (ACAD) affects 0.2-10% of people, often the right coronary artery. Management involves medical therapy, with surgical options for severe cases.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Aneurysmal coronary artery disease (ACAD) encompasses coronary artery aneurysms (CAA) and coronary artery ectasia (CAE).
- Prevalence varies (0.2-10%), with male predominance and a tendency for the right coronary artery (RCA).
- Atherosclerosis is the primary cause in adults; Kawasaki disease in children/adolescents and the Far East.
Purpose of the Study:
- To review the epidemiology, diagnosis, and management of aneurysmal coronary artery disease.
- To highlight diagnostic modalities and treatment strategies for ACAD.
Main Methods:
- Review of existing literature on ACAD prevalence, causes, and clinical presentation.
- Discussion of diagnostic tools, including coronary angiography and noninvasive imaging.
- Analysis of current management strategies, encompassing medical therapy and surgical interventions.
Main Results:
- ACAD most commonly affects the RCA, with atherosclerosis and Kawasaki disease as leading causes.
- Most patients are asymptomatic; symptoms often relate to myocardial ischemia.
- Coronary angiography is standard for diagnosis, with noninvasive imaging preferred for follow-up.
Conclusions:
- Optimal ACAD management remains debated, with medical therapy (antiplatelets/anticoagulants) as the mainstay.
- Covered stents can prevent further expansion; surgical options exist for complex cases.
- Further research is needed to establish definitive management guidelines for ACAD.
Abstract:
Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease.
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