title: Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.
abstract: Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.
authors.affiliation: Division of Cardiology, University of California, San Francisco, San Francisco, California, USA. nathan.boyer@ucsf.edu.
authors.forename: Nathan
authors.initials: N
authors.lastname: Boyer
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Alex
authors.initials: A
authors.lastname: Schevchuck
authors.forename: Vindhya
authors.initials: V
authors.lastname: Hindnavis
authors.forename: Seth
authors.initials: S
authors.lastname: Maliske
authors.forename: Mark
authors.initials: M
authors.lastname: Sheldon
authors.forename: Douglas
authors.initials: D
authors.lastname: Drachman
authors.forename: Yerem
authors.initials: Y
authors.lastname: Yeghiazarians
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000369:Aged, 80 and over; D000465:Algorithms; D000572:American Heart Association; D015897:Comorbidity; D003323:Coronary Aneurysm / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors