Damay Vito, Pranata Raymond, Wiharja Wendy
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Banten, Indonesia.
Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Banten, Indonesia.
J Med Case Rep. 2019 Mar 9;13(1):78. doi: 10.1186/s13256-019-1979-x.
Coronary artery ectasia is characterized by an abnormal dilatation of the coronary arteries. Coronary artery ectasia is observed in 3-8% of patients undergoing coronary angiography and sometimes leads to acute coronary syndrome regardless of the presence or absence of coronary stenosis or atrial fibrillation.
A 61-year-old Indonesian man presented with typical angina that began 1 week before admission and had worsened 3 hours prior to admission. Accompanying symptoms included dyspnea, nausea, and sweating. He was hemodynamically stable and had a history of tobacco smoking and dyslipidemia. An electrocardiogram showed ST-segment depression and T inversion. Laboratory results showed an international normalized ratio of 1.28. Dual antiplatelet therapy was administered along with fondaparinux, and symptoms were alleviated. Coronary angiography showed an ectatic and turbulent mid-distal right coronary artery and slow flow at the first presentation. There was a patent stent in the proximal-mid left anterior descending coronary artery. This patient had previously presented with recurrent acute coronary syndrome and received two coronary stents for the stenotic vessels.
He had right coronary artery ectasia and experienced recurrent acute coronary syndrome. He received dual antiplatelet therapy along with warfarin after stenting of his left anterior descending coronary artery. However, he presented with unstable angina pectoris 7 months before the latest admission and at the latest admission despite a patent stent and no other significant obstructive lesion. The unstable angina pectoris might have been caused by slow flow, microvascular angina caused by small thrombi and/or vasospasm, or epicardial thrombosis at the ectatic coronary artery that dissolved after anticoagulation therapy prior to coronary angiography. Anticoagulant therapy may have a greater benefit than antiplatelet therapy in this patient due to the turbulence and stasis of blood in the ectatic vessel, although coexisting coronary conditions mandated antiplatelet therapy. His international normalized ratio was suboptimal and needed to be improved.
Coronary ectasia may play a role in recurrent acute coronary syndrome, and administration of an anticoagulant to prevent acute coronary syndrome in this patient was in accordance with the varying hemodynamic property of coronary artery ectasia.
冠状动脉扩张的特征是冠状动脉异常扩张。在接受冠状动脉造影的患者中，3%至8%观察到冠状动脉扩张，并且有时会导致急性冠状动脉综合征，无论是否存在冠状动脉狭窄或心房颤动。
一名61岁的印度尼西亚男子因典型心绞痛入院，该症状在入院前1周开始出现，并在入院前3小时加重。伴随症状包括呼吸困难、恶心和出汗。他血流动力学稳定，有吸烟史和血脂异常。心电图显示ST段压低和T波倒置。实验室结果显示国际标准化比值为1.28。给予双联抗血小板治疗并联合磺达肝癸钠，症状得到缓解。冠状动脉造影显示首次就诊时右冠状动脉中远端扩张且血流紊乱，血流缓慢。左前降支冠状动脉近端至中段有一个通畅的支架。该患者此前曾出现复发性急性冠状动脉综合征，并因血管狭窄接受了两个冠状动脉支架植入术。
他患有右冠状动脉扩张，并经历了复发性急性冠状动脉综合征。左前降支冠状动脉支架植入术后，他接受了双联抗血小板治疗并联合华法林。然而，在最近一次入院前7个月以及最近一次入院时，尽管支架通畅且无其他明显阻塞性病变，他仍出现了不稳定型心绞痛。不稳定型心绞痛可能是由血流缓慢、小血栓和/或血管痉挛引起的微血管性心绞痛，或者是冠状动脉造影前抗凝治疗后扩张冠状动脉处的心外膜血栓溶解所致。由于扩张血管内血液的湍流和淤滞，抗凝治疗对该患者可能比抗血小板治疗更有益，尽管并存的冠状动脉疾病需要抗血小板治疗。他的国际标准化比值未达最佳水平，需要改善。
冠状动脉扩张可能在复发性急性冠状动脉综合征中起作用，对该患者使用抗凝剂预防急性冠状动脉综合征符合冠状动脉扩张不同的血流动力学特性。
