ST-Elevation Myocardial Infarction in Coronary Ectasia: A Case Report

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Abstract

Coronary artery ectasia (CAE) is localized or diffuse dilatation of the coronary artery lumen exceeding the diameter of adjacent healthy reference segments by 1.5 times. It is a rare phenomenon and incidence ranges from 1 to 5% in patients undergoing angiography. We report a case of a 58-year-old man with atherosclerotic CAE who experienced ST-elevation myocardial infarction (STEMI) despite prophylactic antiplatelet therapy. He was successfully treated with IV eptifibatide and aspiration thrombectomy. We reviewed the literature of CAE presentation, etiology and treatment and discussed the most appropriate antithrombotic therapy to prevent STEMIs in patients with CAE. While the current literature appears to favour prophylactic antiplatelet and anticoagulant in these patients, more studies are needed to determine the optimal form and duration of antithrombotic therapy. Currently, there is no gold standard treatment for CAE and further prospective and randomized-controlled studies are needed to guide recommendations.

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Pathogenetic mechanisms of coronary ectasia.

Antonios P Antoniadis, Yiannis S Chatzizisis, George D Giannoglou (2008)

Coronary ectasia is defined as local or generalized aneurysmal dilatation of the coronary arteries. The present review summarizes the molecular, cellular and vascular mechanisms which are involved in the pathobiology of coronary ectasia. Coronary ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth. Enzymatic degradation of the extracellular matrix of the media is the major pathophysiologic process that leads to ectasia. Atherosclerotic lesions within ectatic regions of the coronary arteries appear to be highly inflamed high-risk plaques with proclivity to rupture. Better understanding of the pathogenetic processes involved in coronary ectasia is anticipated that will provide a further insight into the clinical significance and natural history of this entity, and may also have direct clinical implications in the management and follow-up strategy of this condition.

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Coronary artery ectasias: imaging, functional assessment and clinical implications.

Dennis V. Cokkinos, Athanassios Manginas (2006)

Coronary artery ectasia is a relatively common entity characterized by inappropriate dilatation of the coronary vasculature. The exact mechanism of its development is unknown, but evidence suggests a combination of genetic predisposition, common risk factors for coronary artery disease and abnormal vessel wall metabolism. It frequently coexists with aneurysms elsewhere, mostly involving the aorta. In this review, the flow disturbances that are associated with this condition and the imaging modalities, which can be used for diagnosis and prospective follow-up are described. The prognosis of coronary ectasias is controversial and prospective studies focusing on conservative or invasive strategies to prevent cardiac complications are needed.

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Coronary artery ectasia: new insights into pathophysiology, diagnosis, and treatment.

Amnon Eitan, Ariel Roguin (2016)

Coronary artery ectasia (CAE) is defined as a segment of the coronary artery that has a diameter of more than 1.5 times the normal adjacent segments. It was described many years ago, but many aspects of this phenomenon are still unknown. It can be found in 1.2-2% of patients referred for coronary angiography. Risk factors are similar to atherosclerosis, but not in all patients. Histology shows extensive destruction of the musculoelastic elements, with marked degradation of the medial collagen and elastin fibers with disruption of the internal and external elastic lamina. These patients have abnormal levels of matrix metalloproteinases and other related proteins. Yet, the actual etiology of CAE is still unknown. Advances in new and improved imaging modalities such as CT and magnetic resonance angiography enable easier and more accessible diagnosis and evaluation. Treatment is aimed mostly at common cardiovascular risk factors. In small series, CAE was associated with worse prognosis. Anticoagulation was never examined in large trials. Nitrates worsen the flow and should not be administered. Interventional treatments are also an option, but a challenging one. This review presents an update on the current knowledge on CAE.

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Author and article information

Journal

Journal ID (nlm-ta): Diseases

Journal ID (iso-abbrev): Diseases

Journal ID (publisher-id): diseases

Title: Diseases

Publisher: MDPI

ISSN (Electronic): 2079-9721

Publication date (Electronic): 16 November 2018

Publication date Collection: December 2018

Volume: 6

Issue: 4

Electronic Location Identifier: 104

Affiliations

Division of Cardiology and Cardiovascular Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; sallyhyejichoi@ 123456gmail.com (H.J.C.); cluong@ 123456ualberta.ca (C.L.); a.fung@ 123456ubc.ca (A.F.)

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[* ]Correspondence: t.tsang@ 123456ubc.ca ; Tel.: +1-604-875-5067

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Hye Ji (Sally) Choi https://orcid.org/0000-0001-8844-6645

Christina Luong https://orcid.org/0000-0002-7514-6069

Article

Publisher ID: diseases-06-00104

DOI: 10.3390/diseases6040104

PMC ID: 6313525

PubMed ID: 30453473

SO-VID: b2dce17c-f006-4a96-a457-06c6068f614c

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

ST-Elevation Myocardial Infarction in Coronary Ectasia: A Case Report

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Most cited references 7

Pathogenetic mechanisms of coronary ectasia.

Coronary artery ectasias: imaging, functional assessment and clinical implications.

Coronary artery ectasia: new insights into pathophysiology, diagnosis, and treatment.

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