Woźniak Patrycja, Iwańczyk Sylwia, Błaszyk Maciej, Stępień Konrad, Lesiak Maciej, Mularek-Kubzdela Tatiana, Araszkiewicz Aleksander
1st Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2 Street, 61-848 Poznań, Poland.
Department of Radiology, Poznan University of Medical Sciences, 61-701 Poznań, Poland.
Biomedicines. 2024 Sep 2;12(9):1984. doi: 10.3390/biomedicines12091984.
Coronary artery aneurysm or ectasia (CAAE) is a term that includes both coronary artery ectasia (CAE) and coronary artery aneurysm (CAA), despite distinct phenotypes and definitions. This anomaly can be found in 0.15-5.3% of coronary angiography. CAE is a diffuse dilatation of the coronary artery at least 1.5 times wider than the diameter of the normal coronary artery in a patient with a length of over 20 mm or greater than one-third of the vessel. CAE can be further subdivided into diffuse and focal dilations by the number and the length of the dilated vessels. Histologically, it presents with extensive destruction of musculoelastic elements, marked degradation of collagen and elastic fibers, and disruption of the elastic lamina. Conversely, CAA is a focal lesion manifesting as focal dilatation, which can be fusiform (if the longitudinal diameter is greater than the transverse) or saccular (if the longitudinal diameter is smaller than the transverse). Giant CAA is defined as a 4-fold enlargement of the vessel diameter and is observed in only 0.02% of patients after coronary. An aneurysmal lesion can be either single or multiple. It can be either a congenital or acquired phenomenon. The pathophysiological mechanisms responsible for the formation of CAAE are not well understood. Atherosclerosis is the most common etiology of CAAE in adults, while Kawasaki disease is the most common in children. Other etiological factors include systemic connective tissue diseases, infectious diseases, vasculitis, congenital anomalies, genetic factors, and idiopathic CAA. Invasive assessment of CAAE is based on coronary angiography. Coronary computed tomography (CT) is a noninvasive method that enables accurate evaluation of aneurysm size and location. The most common complications are coronary spasm, local thrombosis, distal embolization, coronary artery rupture, and compression of adjacent structures by giant coronary aneurysms. The approach to each patient with CAAE should depend on the severity of symptoms, anatomical structure, size, and location of the aneurysm. Treatment methods should be carefully considered to avoid possible complications of CAAE. Simultaneously, we should not unnecessarily expose the patient to the risk of intervention or surgical treatment. Patients can be offered conservative or invasive treatment. However, there are still numerous controversies and ambiguities regarding the etiology, prognosis, and treatment of patients with coronary artery aneurysms. This study summarizes the current knowledge about this disease's etiology, pathogenesis, and management.
冠状动脉瘤或扩张（CAAE）是一个术语，涵盖了冠状动脉扩张（CAE）和冠状动脉瘤（CAA），尽管它们具有不同的表型和定义。这种异常在0.15%-5.3%的冠状动脉造影中可见。CAE是冠状动脉的弥漫性扩张，在患者中其直径至少比正常冠状动脉直径宽1.5倍，长度超过20毫米或大于血管长度的三分之一。CAE可根据扩张血管的数量和长度进一步细分为弥漫性和局灶性扩张。在组织学上，它表现为肌弹性成分的广泛破坏、胶原纤维和弹性纤维的明显降解以及弹性膜的破坏。相反，CAA是一种局灶性病变，表现为局灶性扩张，可为梭形（如果纵向直径大于横向直径）或囊状（如果纵向直径小于横向直径）。巨大CAA定义为血管直径增大4倍，在冠状动脉造影后的患者中仅0.02%可见。动脉瘤性病变可以是单发或多发。它可以是先天性或后天性现象。导致CAAE形成的病理生理机制尚不完全清楚。动脉粥样硬化是成人CAAE最常见的病因，而川崎病在儿童中最为常见。其他病因包括全身性结缔组织疾病、传染病、血管炎、先天性异常、遗传因素和特发性CAA。CAAE的侵入性评估基于冠状动脉造影。冠状动脉计算机断层扫描（CT）是一种非侵入性方法，能够准确评估动脉瘤的大小和位置。最常见的并发症是冠状动脉痉挛、局部血栓形成、远端栓塞、冠状动脉破裂以及巨大冠状动脉瘤对相邻结构的压迫。对每位CAAE患者的治疗方法应取决于症状的严重程度、动脉瘤的解剖结构、大小和位置。应仔细考虑治疗方法以避免CAAE可能的并发症。同时，我们不应不必要地使患者面临介入或手术治疗的风险。患者可接受保守或侵入性治疗。然而，关于冠状动脉瘤患者的病因、预后和治疗仍存在众多争议和模糊之处。本研究总结了关于该疾病病因、发病机制和管理的当前知识。
