Abugroun Ashraf, Vilchez Daniel, Hallak Osama, Shahrrava Anahita
Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.
Cardiol Res. 2017 Dec;8(6):344-348. doi: 10.14740/cr641w. Epub 2017 Dec 22.
Coronary artery ectasia (CAE) is an uncommon anomaly, usually found in 1.2-2% of patients undergoing coronary angiography, defined as a segment of the coronary artery that has a diameter of more than 1.5 times the normal adjacent segments. Atherosclerosis is considered as the cause of half of the CAE cases. We herein present a 65-year-old Asian male with past medical history of Kawasaki disease (KD) who developed recurrent episodes of inferior wall ST-elevation myocardial infarction (STEMI) despite treatment with dual antiplatelet therapy (DAPT). Repeat coronary angiogram showed severely ectatic and tortuous coronary arteries more predominant on the right coronary artery (RCA) with diffuse thrombus in its mid segment. Given his unfavorable vascular anatomy, the condition was managed medically with the addition of warfarin to his DAPT with target international normalized ratio (INR) 2 - 3. This case highlights the association of CAE with a prior history of KD and its therapeutic challenge.
冠状动脉扩张（CAE）是一种罕见的异常情况，通常在1.2%-2%接受冠状动脉造影的患者中发现，定义为冠状动脉的一段直径超过相邻正常节段的1.5倍。动脉粥样硬化被认为是一半CAE病例的病因。我们在此报告一名65岁的亚洲男性，既往有川崎病（KD）病史，尽管接受了双联抗血小板治疗（DAPT），仍反复发生下壁ST段抬高型心肌梗死（STEMI）。重复冠状动脉造影显示冠状动脉严重扩张和迂曲，以右冠状动脉（RCA）更为明显，其中段有弥漫性血栓形成。鉴于其不利的血管解剖结构，对该患者采用在DAPT基础上加用华法林进行药物治疗，目标国际标准化比值（INR）为2-3。该病例突出了CAE与既往KD病史的关联及其治疗挑战。
