Transcript Coronary ectasia

Coronary ectasia
• Angiographic finding of abnormal coronary dilatation
• vessel considered ectatic when its luminal diameter
exceeded 1.5 fold the adjacent normal segment
• Discrete ectasia when the ectatic segment was <1 cm
• Diffuse ectasia when it was ≥1 cm in length
Coronary Artery Surgery Study (CASS): a randomized trialof coronary artery bypass
surgery, survival data. Circulation1983; 68:939–50
Classification
Markis classification with modification
(I) Isolated diffuse ectasia
(a) in only one vessel
(b) in 2 or all 3 coronary vessels
(II) Diffuse and discrete ectasia in combination
(a) Discrete involvement of 1 artery with diffuse involvement of 2 or
3 coronary arteries
(b) Diffuse in 1 and discrete involvement of two or more coronary
arteries
(c) Diffuse in 1 and discrete in one coronary vessel
(III) Isolated discrete ectasia
(a) in one vessel
(b) in two or more coronaries
(IV) Involvement of left main coronary artery (LMCA)
(a) isolated involvement
(b) involvement of other vessels
• prevalence of 1.9%
• A predominance of the male sex 83%
• 6938 angiograms retrospectively analyzed, ectasia without flow limiting
CAD was found in 134 patients
•
The Prevalence and Clinical Profile of Angiographic Coronary Ectasia;Asian
Cardiovasc Thorac Ann 2003;11:122-126 Sugirtham Peter Nyamu, Mullasari S Ajit,
Peter K Joseph, Lakshmi Venkitachalam and Nancy A
• No specific age pattern
• Mechanisms
• Arteriosclerotic disease resulting in weakening of media and
post - stenotic dilatation with post – stenosis flow velocity
augmentation
• Discrete ectasia develops exclusively in the presence of tight
stenosis
Tunick PA, Slater J, Kronzon I, Glassman E. Discrete atherosclerotic coronary
artery aneurysms: a study of 20 patients. J Am Coll Cardiol 1990; 15:279–82.
• Patients with isolated discrete ectasia without significant coexisting stenosis may also seen
•
The Prevalence and Clinical Profile of Angiographic Coronary Ectasia;Asian
Cardiovasc Thorac Ann 2003;11:122-126 Sugirtham Peter Nyamu, Mullasari S
Ajit, Peter K Joseph, Lakshmi Venkitachalam and Nancy A
• Lipid abnormalities have been incriminated in the
genesis of ectasia
• Increased prevalence in patients with Familial
Hypercholesterolemia and a strong inverse
association between H DL and ectasia
Sudhir K, Ports TA, Amidon TM, Goldberger JJ, BhushanV, Kane JP et al.
Increased prevalence of coronary ectasia in heterozygous familial
hypercholesterolemia. Circulation1995; 91:1375–80
• Coronary ectasia in the absence of flow-limiting CAD
may not be completely innocuous, since there is an
association with angina and myocardial infarction
• Thus, the suggestion of the 'slow-flow‘ phenomenon
and in-situ thrombosis even in the absence of
obstructive CAD probably holds true