Dahhan Ali
Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.
Cardiovasc Ther. 2015 Apr;33(2):79-88. doi: 10.1111/1755-5922.12106.
Coronary artery ectasia (CAE) or aneurysm is usually defined as dilation ≥1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologies-mainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, β-blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.
冠状动脉扩张（CAE）或动脉瘤通常定义为血管直径扩张至正常直径的1.5倍及以上。其发病率为1.4%-5.3%，与多种病因相关，主要是先天性、动脉粥样硬化性和炎症性病因。CAE在镰状细胞病中非常常见，在镰状细胞性状个体中也可能常见，发病率为17.7%。它可能与血红蛋白S相关的炎症过程有关。预后主要取决于潜在病因。与无扩张的动脉粥样硬化性冠状动脉疾病（ACAD）相比，动脉粥样硬化性CAE不会带来额外风险。然而，在无ACAD的情况下，孤立性CAE因血管痉挛、冠状动脉血流缓慢和血栓形成，尤其是在扩张段内，发生心肌梗死（MI）的风险增加。由于缺乏研究和指南，管理建议基于个人经验。治疗应在评估严重程度、并发症史、潜在病因和合并症后针对每个病例进行个体化调整。治疗潜在疾病并避免加重因素至关重要。一般来说，药物治疗可能包括抗血小板药物、β受体阻滞剂、血管紧张素转换酶抑制剂、他汀类药物和二氢吡啶类钙通道阻滞剂。在严重CAE或有MI病史的情况下，在评估出血风险后添加抗凝治疗可能是必要的。在急性MI中，扩张段内的大量血栓负荷使经皮介入治疗极具挑战性。抽吸尝试可能导致远端血栓栓塞。搭桥手术的生存率优于药物治疗。尽管如此，搭桥手术并不能提高动脉粥样硬化性CAE的生存率。根据动脉瘤的物理特征，可以寻求不同的手术方法；然而，理想的方法尚不清楚。
