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Coronary Artery Aneurysm: Evaluation, Prognosis, and Proposed Treatment Strategies
Azeem S Sheikh1, Ahmed Hailan2, Tim Kinnaird1
1Department of Cardiology, University Hospital of Wales, Cardiff, UK.
Insights
Coronary artery aneurysms are rare but increasingly linked to drug-eluting stents. This study reviews cases and proposes management strategies for this challenging condition.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery aneurysm (CAA) is a rare condition affecting 0.3%-4.9% of patients post-coronary angiography.
- Atherosclerosis is the primary cause in adults, while Kawasaki disease dominates pediatric cases.
- Drug-eluting stents are increasingly associated with CAA development post-procedure.
Purpose of the Study:
- To investigate the pathophysiology, diagnosis, and treatment of coronary artery aneurysms.
- To present four distinct case studies of CAA management.
- To review current literature and propose therapeutic strategies for coronary artery aneurysms.
Main Methods:
- Coronary angiography as the gold standard for diagnosis, assessing size, shape, and location.
- Review of current literature on coronary artery aneurysm etiology and management.
- Analysis of four clinical cases with varied management approaches.
Main Results:
- Coronary angiography provides crucial anatomical information for surgical planning.
- Pathophysiology involves arterial wall destruction, thinning, increased stress, and dilatation.
- Treatment options for CAA remain poorly defined, presenting a therapeutic challenge.
Conclusions:
- Coronary artery aneurysms, particularly those linked to stents, require further investigation.
- Standardized diagnostic and management protocols for CAA are needed.
- Proposed treatment strategies aim to address the therapeutic challenges posed by CAA.
Abstract:
Coronary artery aneurysm is a rare disorder, which occurs in 0.3%-4.9% of patients undergoing coronary angiography. Atherosclerosis accounts for >90% of coronary artery aneurysms in adults, whereas Kawasaki disease is responsible for most cases in children. Recently, with the advent of implantation of drug-eluting stents, there are increasing reports suggesting stents causing coronary aneurysms, months or years after the procedure. The pathophysiology of coronary artery aneurysm is not completely understood but is thought to be similar to that for aneurysms of larger vessels, with the destruction of arterial media, thinning of the arterial wall, increased wall stress, and progressive dilatation of the coronary artery segment. Coronary angiography remains the gold standard tool, providing information about the size, shape, and location and is also useful for planning the strategy of surgical resection. The natural history and prognosis remain unclear. Despite the important anatomical abnormality of the coronary artery, the treatment options of coronary artery aneuryms are still poorly defined and present a therapeutic challenge. We describe four cases, which were managed differently followed by a review of the current literature and propose some treatment strategies.
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