Invasive and anticoagulant treatment for coronary ectasia: a single operator's experience in a tertiary hospital in South Africa.
BACKGROUND
Coronary artery ectasia (CAE) is a rare but well-recognised condition involving dilatation of a coronary artery to more than 1.5 times the diameter of the adjacent portion of the artery. As far as we are aware, the disease has not been described in any local literature and no other research has been conducted in Africa. We carried out this research in order to establish the incidence of the condition in South Africa, as well as the possible preferred method of treatment.


METHODS
Cases were identified from the database of the practice. The study involved only patients who were classified to have Markis type I, II and III disease. From a total of approximately 2,000 angiographies performed during the study period, CAE types I, II and III were diagnosed in 20 patients. Patients with type IV CAE were excluded from the group. Nineteen patients were male and were in their fourth or fifth decade of life, and one was female. Three of the patients were Indian, one was black, and the rest were white.


RESULTS
Four patients in the group had diabetes, 13 were smokers and eight had hypertension. Dyslipidaemia was observed in seven patients. The most commonly affected area of the coronary artery was the RCA-19 (isolated, or in combination). Patients were treated mainly with anticoagulation and, when necessary, with angioplasty and stent implantation. Morbidity was seen in 5% of the patients and no mortality was observed.


CONCLUSIONS
Most of the patients were male, and the occlusion involved mostly the right coronary artery. The cause of occlusion is still unknown, but it is thought to be due to slow blood flow, damaged endothelium, or a combination of the two. The best therapeutic approach is not known as yet.
Grigorov
V
V
ARWYP Medical Centre and Glynwood Hospital, Johannesburg, South Africa. vgrigorov2001@yahoo.com
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002404:Catheterization; D003131:Combined Modality Therapy; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology; D003331:Coronary Vessels / Q000473:pathology*; D004108:Dilatation, Pathologic; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D013019:South Africa / Q000453:epidemiology
D000925:Anticoagulants; D017984:Enoxaparin
Br Heart J. 1985 Oct;54(4):392-5
4052280
Am J Cardiol. 1976 Feb;37(2):217-22
1108631
Mayo Clin Proc. 1985 Dec;60(12):822-6
4068760
Hum Pathol. 1986 Jun;17(6):575-83
3710470
Am Heart J. 1985 Apr;109(4):785-91
3984833
Am Heart J. 1995 Oct;130(4):765-71
7572584
Ann Acad Med Singap. 2004 Jul;33(4):419-22
15329751
Radiology. 1966 Jul;87(1):33-4
5940472
J Thorac Cardiovasc Surg. 1994 Jun;107(6):1532-5
8196402
J Am Coll Cardiol. 2001 Aug;38(2):297-306
11499716
Heart. 1997 Aug;78(2):136-41
9326986
Am J Cardiol. 2004 Dec 1;94(11):1433-5
15566920
Circulation. 1983 Jan;67(1):134-8
6847792
Am J Med. 1969 Dec;47(6):967-77
5362873
Br Heart J. 1978 Apr;40(4):393-400
646906
Lancet. 1996 Jan 20;347(8995):136-7
8544543
Catheter Cardiovasc Interv. 2002 Feb;55(2):222-7
11835652
Cardiology. 1999;91(3):145-9
10516406
Am J Med. 1977 Apr;62(4):597-607
300567
Cardiovasc J S Afr. 2002 May-Jun;13(3):125-8
12193965
JAMA. 1971 Sep 20;217(12):1666-70
4398421
Indian Heart J. 2000 Sep-Oct;52(5):547-53
11256777