Coronary artery aneurysm: Difference between revisions

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==Overview==
==Overview==
Coronary artery aneurysm is an abnormal dilatation of a [[coronary artery]] segment over 1.5 times the diameter of normal adjacent segment.<ref name="pmid4897732">{{cite journal| author=Jarcho S| title=Bougon on coronary aneurysm (1812). | journal=Am J Cardiol | year= 1969 | volume= 24 | issue= 4 | pages= 551-3 | pmid=4897732 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4897732  }} </ref>
Coronary artery aneurysm is an abnormal dilatation of a [[coronary artery]] segment over 1.5 times the diameter of normal adjacent segment.<ref name="pmid4897732">{{cite journal| author=Jarcho S| title=Bougon on coronary aneurysm (1812). | journal=Am J Cardiol | year= 1969 | volume= 24 | issue= 4 | pages= 551-3 | pmid=4897732 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4897732  }} </ref> An [[aneurysm]] can be classified as either [[saccular]] (wider than it is long) or [[fusiform]] (elongated).


==Epidemiology and Demographics==
==Grading System==
* The incidence of CAA ranges widely between 0.3-5.3% within angiographic series with a mean incidence of 1.65%.<ref name="pmid4052280">{{cite journal| author=Hartnell GG, Parnell BM, Pridie RB| title=Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. | journal=Br Heart J | year= 1985 | volume= 54 | issue= 4 | pages= 392-5 | pmid=4052280 | doi= | pmc=PMC481917 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4052280  }} </ref> A highest incidence of 10-12% was reported in a study from India. Perhaps reflecting a specific genetic and/or environmental predisposition.<ref name="pmid2086442">{{cite journal| author=Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK et al.| title=Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. | journal=Indian Heart J | year= 1990 | volume= 42 | issue= 5 | pages= 365-9 | pmid=2086442 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2086442  }} </ref>
 
* CAA most commonly occurs in [[right coronary artery]] accounting for 40-87% followed by [[left anterior descending artery]] and [[left circumflex artery]].<ref name="pmid16230889">{{cite journal| author=Villines TC, Avedissian LS, Elgin EE| title=Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review. | journal=Cardiol Rev | year= 2005 | volume= 13 | issue= 6 | pages= 309-11 | pmid=16230889 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16230889  }} </ref><ref name="pmid6847792">{{cite journal| author=Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG et al.| title=Aneurysmal coronary artery disease. | journal=Circulation | year= 1983 | volume= 67 | issue= 1 | pages= 134-8 | pmid=6847792 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6847792  }} </ref>
 
* CAA of left main artery or triple-vessel CAA are rare.<ref name="pmid16230889">{{cite journal| author=Villines TC, Avedissian LS, Elgin EE| title=Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review. | journal=Cardiol Rev | year= 2005 | volume= 13 | issue= 6 | pages= 309-11 | pmid=16230889 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16230889  }} </ref>
 
==Diagnosis==
 
It is often found coincidentally on [[coronary angiography]].<ref name="pmid17063947">{{cite journal |author=Pahlavan PS, Niroomand F |title=Coronary artery aneurysm: a review |journal=Clin Cardiol |volume=29 |issue=10 |pages=439–43 |year=2006 |month=October |pmid=17063947 |doi= |url=}}</ref>
 
==Causes==
 
Causes include [[atherosclerosis]],<ref name="pmid18466032">{{cite journal |author=Nichols L, Lagana S, Parwani A |title=Coronary artery aneurysm: a review and hypothesis regarding etiology |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=5 |pages=823–8 |year=2008 |month=May |pmid=18466032 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=823}}</ref> [[Kawasaki disease]]<ref name="pmid17456996">{{cite journal |author=Fukazawa R, Ikegam E, Watanabe M, ''et al'' |title=Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence |journal=Circ. J. |volume=71 |issue=5 |pages=709–15 |year=2007 |month=May |pmid=17456996 |doi= |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/circj/71.709?from=PubMed}}</ref> and [[coronary catheterization]] as well as vasculitides and collagen vascular diseases.
 
==Prognosis==
 
It has a good prognosis.<ref name="pmid17063947">{{cite journal |author=Pahlavan PS, Niroomand F |title=Coronary artery aneurysm: a review |journal=Clin Cardiol |volume=29 |issue=10 |pages=439–43 |year=2006 |month=October |pmid=17063947 |doi= |url=}}</ref>
 
==Definition==


A localized arterial widening (dilatation) that usually manifests itself as a bulge. Its presence may lead to weakening of the wall and eventual rupture.
A localized arterial widening (dilatation) that usually manifests itself as a bulge. Its presence may lead to weakening of the wall and eventual rupture.
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Aneurysm – visual assessment of an [[aneurysm]] > 1.5 times the normal artery diameter located anywhere in the culprit artery.
Aneurysm – visual assessment of an [[aneurysm]] > 1.5 times the normal artery diameter located anywhere in the culprit artery.


*NOTE: An [[aneurysm]] can be further classified as either [[saccular]] (wider than it is long) or [[fusiform]] (elongated).
Shown below are an animated image and a static image depicting an aneurysm in the [[left coronary artery]].  Outlined in yellow in the image on the right is the localized aneurysm which is a dilatation of the coronary artery segment >1.5 times the diameter of the adjacent segments on the [[LCA]].
 
[[Image:Coronary-artery-aneurysm.gif|300px|Left coronary artery aneurysm]]
[[Image:Coronary artery aneurysm static.gif|300px|Left coronary artery aneurysm]]
 
==Epidemiology and Demographics==
* The incidence of CAA ranges widely between 0.3-5.3% within angiographic series with a mean incidence of 1.65%.<ref name="pmid4052280">{{cite journal| author=Hartnell GG, Parnell BM, Pridie RB| title=Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. | journal=Br Heart J | year= 1985 | volume= 54 | issue= 4 | pages= 392-5 | pmid=4052280 | doi= | pmc=PMC481917 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4052280  }} </ref> A highest incidence of 10-12% was reported in a study from India. Perhaps reflecting a specific genetic and/or environmental predisposition.<ref name="pmid2086442">{{cite journal| author=Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK et al.| title=Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study. | journal=Indian Heart J | year= 1990 | volume= 42 | issue= 5 | pages= 365-9 | pmid=2086442 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2086442  }} </ref>
 
* CAA most commonly occurs in [[right coronary artery]] accounting for 40-87% followed by [[left anterior descending artery]] and [[left circumflex artery]].<ref name="pmid16230889">{{cite journal| author=Villines TC, Avedissian LS, Elgin EE| title=Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review. | journal=Cardiol Rev | year= 2005 | volume= 13 | issue= 6 | pages= 309-11 | pmid=16230889 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16230889  }} </ref><ref name="pmid6847792">{{cite journal| author=Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG et al.| title=Aneurysmal coronary artery disease. | journal=Circulation | year= 1983 | volume= 67 | issue= 1 | pages= 134-8 | pmid=6847792 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6847792  }} </ref>


==Angiography Examples==
* CAA of left main artery or triple-vessel CAA are rare.<ref name="pmid16230889">{{cite journal| author=Villines TC, Avedissian LS, Elgin EE| title=Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review. | journal=Cardiol Rev | year= 2005 | volume= 13 | issue= 6 | pages= 309-11 | pmid=16230889 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16230889  }} </ref>
Click '''[[Coronary angiography aneurysm|here]]''' for angiography examples of coronary artery aneurysm.
 
==Prognosis==
Coronary artery aneurysm has a good prognosis.<ref name="pmid17063947">{{cite journal |author=Pahlavan PS, Niroomand F |title=Coronary artery aneurysm: a review |journal=Clin Cardiol |volume=29 |issue=10 |pages=439–43 |year=2006 |month=October |pmid=17063947 |doi= |url=}}</ref>
 
==Causes==
Causes include [[atherosclerosis]],<ref name="pmid18466032">{{cite journal |author=Nichols L, Lagana S, Parwani A |title=Coronary artery aneurysm: a review and hypothesis regarding etiology |journal=Arch. Pathol. Lab. Med. |volume=132 |issue=5 |pages=823–8 |year=2008 |month=May |pmid=18466032 |doi= |url=http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=823}}</ref> [[Kawasaki disease]]<ref name="pmid17456996">{{cite journal |author=Fukazawa R, Ikegam E, Watanabe M, ''et al'' |title=Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence |journal=Circ. J. |volume=71 |issue=5 |pages=709–15 |year=2007 |month=May |pmid=17456996 |doi= |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/circj/71.709?from=PubMed}}</ref> and [[coronary catheterization]] as well as vasculitides and collagen vascular diseases.
 
==Diagnosis==
It is often found coincidentally on [[coronary angiography]].<ref name="pmid17063947">{{cite journal |author=Pahlavan PS, Niroomand F |title=Coronary artery aneurysm: a review |journal=Clin Cardiol |volume=29 |issue=10 |pages=439–43 |year=2006 |month=October |pmid=17063947 |doi= |url=}}</ref>


==References==
==References==

Revision as of 15:10, 6 September 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. [3]

Synonyms and keywords: CAA

Overview

Coronary artery aneurysm is an abnormal dilatation of a coronary artery segment over 1.5 times the diameter of normal adjacent segment.[1] An aneurysm can be classified as either saccular (wider than it is long) or fusiform (elongated).

Grading System

A localized arterial widening (dilatation) that usually manifests itself as a bulge. Its presence may lead to weakening of the wall and eventual rupture.

Grade 0

None – no ectasia present.

Grade 1

Ectasia – visual assessment of ectasia >1 & < 1.5 times the normal artery diameter located anywhere in the culprit artery.

Grade 2

Aneurysm – visual assessment of an aneurysm > 1.5 times the normal artery diameter located anywhere in the culprit artery.

Shown below are an animated image and a static image depicting an aneurysm in the left coronary artery. Outlined in yellow in the image on the right is the localized aneurysm which is a dilatation of the coronary artery segment >1.5 times the diameter of the adjacent segments on the LCA.

Left coronary artery aneurysm Left coronary artery aneurysm

Epidemiology and Demographics

  • The incidence of CAA ranges widely between 0.3-5.3% within angiographic series with a mean incidence of 1.65%.[2] A highest incidence of 10-12% was reported in a study from India. Perhaps reflecting a specific genetic and/or environmental predisposition.[3]
  • CAA of left main artery or triple-vessel CAA are rare.[4]

Prognosis

Coronary artery aneurysm has a good prognosis.[6]

Causes

Causes include atherosclerosis,[7] Kawasaki disease[8] and coronary catheterization as well as vasculitides and collagen vascular diseases.

Diagnosis

It is often found coincidentally on coronary angiography.[6]

References

  1. ↑ Jarcho S (1969). "Bougon on coronary aneurysm (1812)". Am J Cardiol. 24 (4): 551–3. PMID 4897732.
  2. ↑ Hartnell GG, Parnell BM, Pridie RB (1985). "Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients". Br Heart J. 54 (4): 392–5. PMC 481917. PMID 4052280.
  3. ↑ Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK; et al. (1990). "Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study". Indian Heart J. 42 (5): 365–9. PMID 2086442.
  4. ↑ 4.0 4.1 Villines TC, Avedissian LS, Elgin EE (2005). "Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review". Cardiol Rev. 13 (6): 309–11. PMID 16230889.
  5. ↑ Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG; et al. (1983). "Aneurysmal coronary artery disease". Circulation. 67 (1): 134–8. PMID 6847792.
  6. ↑ 6.0 6.1 Pahlavan PS, Niroomand F (2006). "Coronary artery aneurysm: a review". Clin Cardiol. 29 (10): 439–43. PMID 17063947. Unknown parameter |month= ignored (help)
  7. ↑ Nichols L, Lagana S, Parwani A (2008). "Coronary artery aneurysm: a review and hypothesis regarding etiology". Arch. Pathol. Lab. Med. 132 (5): 823–8. PMID 18466032. Unknown parameter |month= ignored (help)
  8. ↑ Fukazawa R, Ikegam E, Watanabe M; et al. (2007). "Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence". Circ. J. 71 (5): 709–15. PMID 17456996. Unknown parameter |month= ignored (help)


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