Medically managed coronary artery aneurysm without concomitant stenosis

Area of Science:

• Cardiology
• Vascular Medicine

Background:

• Coronary artery aneurysms (CAAs) are uncommon cardiovascular conditions.
• Management guidelines for CAAs often focus on those with significant stenosis, recommending surgical or interventional approaches.
• A lack of consensus exists regarding the natural history and management of CAAs without significant concomitant stenosis due to limited case studies and absence of randomized controlled trials.

Observation:

• Atherosclerotic coronary artery aneurysm (CAA) was diagnosed in a patient.
• The CAA was not associated with significant coronary artery stenosis (≥70%).
• The patient was managed medically.

Findings:

• Follow-up coronary angiography performed 11 years after initial diagnosis revealed the absence of the previously identified CAA.
• This suggests that some atherosclerotic CAAs without significant stenosis may undergo spontaneous resolution.
• Medical management may be a viable option for select cases of CAAs without significant stenosis.

Implications:

• This case challenges the current paradigm that intervention is always necessary for CAAs, particularly those without significant stenosis.
• Further research into the natural history and optimal management strategies for CAAs without significant stenosis is warranted.
• The findings suggest a potential for conservative management in selected patients with atherosclerotic CAAs, warranting careful consideration of individual patient factors and aneurysm characteristics.