Coronary Artery Ectasia and Aneurysm: Benign Variant or High-Risk Substrate in Need of Tailored Treatment?

Area of Science:

• Cardiology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Coronary artery aneurysm (CAA) and ectasia (CAE) are defined as abnormal dilations of coronary arteries, typically over 1.5 times the diameter of adjacent segments.
• These conditions are frequently discovered incidentally via coronary computed tomography angiography (CCTA) or invasive coronary angiography.
• Their clinical significance is increasingly recognized due to potential associations with myocardial ischemia, thrombosis, distal embolization, acute coronary syndromes, and adverse long-term outcomes.

Purpose of the Study:

• To review the current understanding of coronary artery aneurysms and ectasia.
• To highlight the diagnostic methods and potential clinical implications of these vascular anomalies.
• To discuss the challenges in risk stratification and management strategies.

Main Methods:

• Review of existing literature on coronary artery aneurysms and ectasia.
• Analysis of diagnostic modalities including coronary computed tomography angiography and invasive coronary angiography.
• Discussion of etiological factors, clinical presentations, and management controversies.

Main Results:

• Atherosclerosis is the primary cause in adults, while Kawasaki disease is the leading cause in children.
• Many patients are asymptomatic, with incidental diagnosis being common.
• Coronary angiography is the gold standard for invasive assessment, but management strategies lack definitive evidence from randomized controlled trials.

Conclusions:

• Coronary artery aneurysms and ectasia are significant vascular conditions with potentially severe complications.
• Individualized clinical risk stratification is crucial due to variable natural history and unclear prognostic implications.
• Optimal therapeutic strategies remain controversial, underscoring the need for further research and randomized controlled trials.