From the Research
Definition of Coronary Ectasia
- Coronary artery ectasia (CAE) is defined as a diffuse or focal dilation of an epicardial coronary artery, which diameter exceeds by at least 1.5 times the normal adjacent segment 1, 2, 3
- CAE can be further subdivided into diffuse and focal dilations by the number and the length of the dilated vessels 1
- It is characterized by abnormal dilatation of the coronary arteries, often associated with atherosclerosis, inflammation, and other diseases 1, 2, 4, 3, 5
Prevalence and Etiology
- The prevalence of CAE ranges between 0.3 and 5% of patients undergoing coronary angiography 1, 3
- Atherosclerosis is the most common etiology of CAE in adults, while Kawasaki disease is the most common in children 1
- Other etiological factors include systemic connective tissue diseases, infectious diseases, vasculitis, congenital anomalies, genetic factors, and idiopathic CAE 1
- CAE is also associated with sickle cell disease, with an incidence of 17.7% 2
Clinical Implications and Prognosis
- Patients with CAE typically present with angina, and are at risk for myocardial infarctions and sudden cardiac death due to slow flow, coronary vasospasm, dissection, and/or intracoronary thrombosis 2, 3, 5
- The prognostic role of CAE is controversial, but previous studies reported a high risk of cardiovascular events and mortality in these patients after percutaneous coronary intervention 3
- Treatment of underlying condition and avoidance of exacerbating factors are essential, and therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities 1, 2, 3
Treatment and Management
- Medical therapy with anticoagulants, nitrates, and calcium channel blockers has been proposed and seems rational, however prospective studies with proof of efficacy are needed 2, 4, 5
- Interventional management of patients with CAE, including covered stent implantation and stent-assisted coil embolization, is challenging and often complicated by distal thrombus embolization and stent malapposition 3
- The optimal antithrombotic therapy is debated and includes dual antiplatelet therapy, anticoagulation, or a combination of them 3