Division of Cardiology, MercyOne-Iowa Heart Center, 1111 6th Ave, Des Moines, IA, 50314, USA.
J Thromb Thrombolysis. 2021 Aug;52(2):683-688. doi: 10.1007/s11239-021-02418-2. Epub 2021 Mar 20.
Coronary artery aneurysm (CAA) is an uncommon coronary disease, with a reported incidence in adults ranging from 0.33 to 4.9%.It is usually considered a variant of coronary artery disease (CAD). CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. CAA identified in the context of acute coronary syndrome (ACS) poses several unique management challenges. Optimal antiplatelet and anticoagulant therapy is the mainstay of therapy. Percutaneous intervention for CAA is associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malposition, dissection, and rupture. There are currently no accepted guidelines to direct the management of CAA in patients presenting with ACS. Preference for conservative vs. surgical or catheter-based management is controversial. We review the literature and report different treatment strategies for two cases with both CAA and ACS.
冠状动脉瘤（CAA）是一种罕见的冠状动脉疾病，据报道成年人的发病率为 0.33%至 4.9%。它通常被认为是冠状动脉疾病（CAD）的一种变异。CAA 由于异常的层流而导致血栓形成，以及 CAA 内异常的血小板和内皮衍生的病理生理因素。在急性冠状动脉综合征（ACS）的背景下发现的 CAA 带来了一些独特的管理挑战。最佳的抗血小板和抗凝治疗是治疗的基础。CAA 的经皮介入治疗与并发症相关，包括血栓的远端栓塞、无复流现象、支架位置不当、夹层和破裂。目前没有公认的指南来指导 ACS 患者的 CAA 管理。对于保守治疗与手术或基于导管的治疗的偏好存在争议。我们回顾文献并报告了两个同时患有 CAA 和 ACS 的病例的不同治疗策略。
