Coronary Artery Ectasia: A Case Report Discussing the Causes, Diagnosis, and Treatment

The localized or diffused dilation of a coronary artery lumen is referred to as coronary artery ectasia (CAE). Though it is well recognized, CAE is a rare finding that is encountered in the diagnostic procedure of coronary angiography. This form of atherosclerotic coronary artery disease (CAD) can be found in 1.4-4.9% of all coronary angiography patients. CAE can manifest in combination with stenotic lesions or present as an isolated condition. Its risk factors are similar to those of atherosclerosis. The underlying pathophysiology involves a vascular remodeling response to atherosclerosis. Enzymatic degradation by matrix metalloproteinases (MMP) and accumulation of lipoproteins play an important role in the remodeling process. CAE can be diagnosed with the help of imaging modalities such as coronary CT angiogram (CTA) and coronary magnetic resonance angiogram (MRA); coronary angiography is considered the gold standard procedure. The management strategies include treating the cardiovascular risk factors, prevention of thromboembolic events, and percutaneous/vascular revascularization. CAE can be managed medically, but percutaneous/surgical revascularization [coronary artery bypass grafting (CABG)] is an option to treat patients with co-existing symptomatic obstructive lesion refractory to medical treatment. Further trials are required to optimize the management guidelines related to CAE. In this report, we describe the case of a 42-year-old man with a past medical history of hypertension, hyperlipidemia, and asthma who presented with shortness of breath and minimally elevated troponin level. Coronary angiography revealed three vessels with ectasia and severe left ventricular dysfunction on ventriculography.