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      Coronary Artery Aneurysm: Evaluation, Prognosis, and Proposed Treatment Strategies

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          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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          Most cited references46

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          Kawasaki syndrome.

          Kawasaki syndrome is an acute, self-limited vasculitis that occurs in children of all ages and presents a challenge for the clinician: the disorder can be difficult to recognise; there is no diagnostic laboratory test; there is an extremely effective therapy; and there is a 25% chance of serious cardiovascular damage if the treatment is not given early in the course of the disease. This review includes discussion of the history of the syndrome, the diagnostic challenges, epidemiology, aetiology, pathology, immunopathogenesis, therapy, genetic influences, and the long-term cardiovascular sequelae.
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            Clinical significance of coronary arterial ectasia.

            In a study group of 2,457 consecutive patients undergoing cardiac catheterization, 30 patients had coronary arterial ectasia, an irregular dilatation of major vessels up to seven times the diameter of branch vessels. The frequency of hypertension, abnormal electrocardiogram and history of myocardial infarction was greater than that in a control group with obstructive coronary artery disease. Patients with ectasia did not differ from patients with obstructive disease in sex, age, prevalence of angina or presence of metabolic abnormalities. Six deaths occurred in the group with ectasia during a mean follow-up period of 24 months (annual rate of 15 percent). Extensive destruction of the musculoelastic elements was evident, resulting in marked attenuation of the vessel wall. The short-term prognosis in this group is the same as in medically treated patients with three vessel obstructive coronary artery disease.
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              Aneurysmal coronary artery disease.

              To examine the clinical and historical features and the natural history of aneurysmal coronary disease, we reviewed the registry data of the Coronary Artery Surgery Study (CASS). Nine hundred seventy-eight patients, representing 4.9% of the total registry population, were identified as having aneurysmal disease. No significant differences were noted between aneurysmal and nonaneurysmal coronary disease patients when features such as hypertension, diabetes, lipid abnormalities, family history, cigarette consumption, incidence of documented myocardial infarction, presence and severity of angina, and presence of peripheral vascular disease were examined. In addition, no difference in 5-year medical survival was noted between these two groups. These findings suggest that aneurysmal coronary disease does not represent a distinct clinical entity but is, rather, a variant of coronary atherosclerosis.
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                Author and article information

                Journal
                Heart Views
                Heart Views
                HV
                Heart Views : The Official Journal of the Gulf Heart Association
                Wolters Kluwer - Medknow (India )
                1995-705X
                0976-5123
                Jul-Sep 2019
                : 20
                : 3
                : 101-108
                Affiliations
                [1]Department of Cardiology, University Hospital of Wales, Cardiff, UK
                [1 ]Department of Cardiology, Morriston Hospital, Swansea, UK
                Author notes
                Address for correspondence: Dr. Azeem S. Sheikh, Interventional Fellow, Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. E-mail: drazeemsheikh@ 123456hotmail.com
                Article
                HV-20-101
                10.4103/HEARTVIEWS.HEARTVIEWS_1_19
                6791093
                31620255
                79bb5eec-b465-43f4-bfbc-39caf964ee14
                Copyright: © 2019 Heart Views

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Review Article

                Cardiovascular Medicine
                atherosclerosis,coronary angiography,coronary artery disease,drug-eluting stent,kawasaki disease,percutaneous coronary intervention

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