Coronary Aneurysmal and Ectatic Disease: Cath-Lab Diagnosis and Contemporary Interventional Management

Coronary aneurysmal and ectatic disease (CAA/CAE) is an increasingly recognized condition in contemporary catheterization laboratory practice and is predominantly associated with atherosclerotic remodeling. It is characterized by excessive positive remodeling, vessel wall degeneration, altered coronary hemodynamics, and a prothrombotic milieu, all of which contribute to an increased risk of ischemic events. Invasive angiography remains the primary diagnostic tool, while intravascular imaging is essential for accurate morphological characterization, detection of intraluminal thrombus, and guidance of percutaneous interventions. Revascularization strategies should be individualized, with percutaneous intervention reserved for flow-limiting lesions and surgery considered for giant or complex aneurysms. Evidence guiding antithrombotic therapy is limited and largely observational. A recent network meta-analysis suggests that dual antiplatelet therapy is associated with the greatest reduction in major adverse cardiovascular events, whereas routine oral anticoagulation has not demonstrated consistent benefit. Current ACC/AHA and ESC guidelines do not provide specific recommendations for aneurysmal disease; therefore, antithrombotic management is generally extrapolated from standard recommendations according to clinical presentation. In conclusion, pending the results of ongoing trials, a phenotype-driven and individualized approach remains the most appropriate management strategy.