Tejas Patel, MD | Sanjay Shah, MD | Samir B. Pancholy, MD

Chapter 3: Coronary Artery Aneurysms

The incidence of coronary artery aneurysm has been reported in the range of 1.5% to 5%.1-6 Aneurysm formation is defined as a widening of arterial lumen greater than 1.5 times the normal native vessel diameter. In the pre-stenting era, approximately 50% of coronary aneurysms were atherosclerotic in nature, and the remaining cases were the result of a combination of inflammatory and/or connective tissue disorders such as Kawasaki disease, Marfan’s syndrome, Ehlers-Danlos syndrome, and syphilis.1-6 In contemporary cardiac practice, iatrogenic coronary aneurysms have been reported following drug-eluting stent (DES) implantation; however, the incidence is small (about 1.25%).3-6 The proposed mechanisms of development of iatrogenic coronary aneurysms include high-pressure inflation leading to injury and “crater” formation, localized hypersensitivity reaction of a drug leading to inflammation, and abnormal healing of the vessel wall.2-6 Two specific goals of management include prevention of aneurysm expansion and maintenance of coronary artery patency. All the aneurysms in coronary circulation should be followed closely for progression. While rupture is almost never a concern, a large aneurysm may require surgical treatment, particularly when associated with symptoms of ischemia. Coronary aneurysms can increase the risk of in-stent restenosis and late stent thrombosis.3-6 Asymptomatic patients with small aneurysms can potentially be followed with computed tomography (CT) coronary angiography or magnetic resonance (MR) coronary angiography. Covered stents, vascular coils, and other embolic materials are the options available to manage aneurysms in the catheterization laboratory.

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