Plehn Gunnar, van Bracht Marc, Zuehlke Christian, Schrage Max Olav, Wickenbrock Ingo, Perings Christian, Trappe Hans-Joachim
Department of Cardiology and Angiology, University of Bochum, Herne, Germany.
Int J Cardiovasc Imaging. 2006 Jun-Aug;22(3-4):311-6. doi: 10.1007/s10554-005-9039-6. Epub 2005 Nov 4.
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.
