From atherosclerotic coronary ectasia to aneurysm: a case report and literature review.
In contrast to Kawasaki syndrome the formation of coronary aneurysms caused by atherosclerosis has hardly been demonstrated. We report on a 56-year old patient, admitted to our hospital for cardiovascular evaluation before carotid surgery. He had no anginal pain, but a history of coronary artery disease with previous anterior myocardial infarction. Angiography revealed a collateralized LAD occlusion. Myocardial scintigraphy only demonstrated fixed perfusion defects. Surprisingly, MR imaging revealed large coronary aneurysms of the RCX and RCA. Angiographic follow up showed a rapid progression of ectatic towards aneurysmatic coronary lesions within 3 years. General pathophysiological mechanisms promoting ectatic coronary artery disease as a structural failure of the atherosclerotic remodelling process itself and chronic dilatatory stimuli due to endogenous and exogenous factors are discussed.
Plehn
Gunnar
G
Department of Cardiology and Angiology, University of Bochum, Herne, Germany. gunnar.plehn@marienhospital-herne.de
van Bracht
Marc
M
Zuehlke
Christian
C
Schrage
Max Olav
MO
Wickenbrock
Ingo
I
Perings
Christian
C
Trappe
Hans-Joachim
HJ
D003287:Contrast Media; D003323:Coronary Aneurysm / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology*; D004108:Dilatation, Pathologic; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
D003287:Contrast Media; D019786:Gadolinium DTPA