Zeb Mehmood, McKenzie Daniel B, Scott Paul A, Talwar Suneel
Wessex Cardiothoracic Centre, Southampton General Hospital, Hampshire, United Kingdom.
J Invasive Cardiol. 2012 Sep;24(9):465-9.
Coronary aneurysms are found in approximately 5% of patients undergoing coronary angiography. Most coronary artery aneurysms (CAAs) are associated with significant stenosis of the coronary lumen; however, there is no common consensus on the treatment of coronary aneurysms. A large aneurysm in the coronary artery makes the blood flow turbulent and predisposes to thrombus formation and coronary artery obstruction even without the presence of significant stenosis. Despite this important anatomical abnormality of the coronary artery, the treatment options are poorly understood and present a therapeutic challenge to the interventional cardiologist. While treating CAAs with percutaneous implantation of covered stents offers a less invasive option compared to surgical correction, the short- and long-term outcomes are unknown. In this article, we have reviewed the literature and discussed the pathophysiology, clinical importance, and treatment options for CAAs. The illustrated case demonstrates a difficult situation in the management of CAA with interesting images, including coronary angiography, intravascular ultrasound, and transesophageal echocardiography of the complication encountered in this particular case.
在接受冠状动脉造影的患者中，约5%会发现冠状动脉瘤。大多数冠状动脉瘤（CAA）与冠状动脉管腔的严重狭窄相关；然而，对于冠状动脉瘤的治疗尚无共识。冠状动脉中的大动脉瘤会使血流紊乱，即使没有明显狭窄也易形成血栓并导致冠状动脉阻塞。尽管冠状动脉存在这种重要的解剖异常，但治疗选择仍知之甚少，这给介入心脏病学家带来了治疗挑战。与手术矫正相比，经皮植入覆膜支架治疗CAA是一种侵入性较小的选择，但其短期和长期疗效尚不清楚。在本文中，我们回顾了相关文献并讨论了CAA的病理生理学、临床重要性及治疗选择。该病例展示了CAA管理中的困难情况，并配有有趣的图像，包括该特定病例中遇到的并发症的冠状动脉造影、血管内超声和经食管超声心动图。
