Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2007 May 9;30(5):214–217. doi: 10.1002/clc.20002

Coronary artery ectasia–Is it time for a reappraisal?

P Ramappa 1, A Kottam 1, H Kuivanemi 2, D Thatai 1,✉
PMCID: PMC6653232  PMID: 17492685

Abstract

Coronary artery ectasia (CAE) is a well recognized clinical entity encountered during diagnostic cardiac catheterization. The etiopathogenesis of this condition is poorly understood. Due to the frequent presence of associated obstructive coronary artery disease it is considered to be a maladaptive process of atherosclerosis. Based on its association with aortic aneurysm, coronary ectasia is considered to be caused by genetic abnormalities. It is usually not a benign condition, as normal smooth laminar flow is disrupted with a potential of thrombus formation. The role of long‐term anticoagulation in this condition has not been well established. It is speculated that with increasing use of newer, noninvasive modalities the incidence of ectasia may rise, therefore necessitating this review. Copyright © 2007 Wiley Periodicals, Inc.

Keywords: coronary artery ectasia, thrombosis, atherosclerosis, coronary artery disease

Full Text

The Full Text of this article is available as a PDF (124.5 KB).

References

  • 1. Hartnell GG, Parnell BM, Pridie RB: Coronary artery ectasia. Its prevalence and clinical significance in 4,993 patients. Br Heart J 1985;54(4): 392–395 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Sorrell VL, Davis MJ, Bove AA: Current knowledge and significance of coronary artery ectasia: A chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations. Clin Cardiol 1998;21:157–160 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Kruger D, Stierle U, Herrmann G, Simon R, Sheikhzadeh A: Exercise‐induced myocardial ischemia in isolated coronary artery ectasias and aneurysms (“dilated coronopathy”). J Am Coll Cardiol 1999;34(5):1461–1470 [DOI] [PubMed] [Google Scholar]
  • 4. Akyurek O, Berkalp B, Sayin T, Kumbasar D, Kervancioglu C, et al.: Altered coronary flow properties in diffuse coronary artery ectasia. Am Heart J 2003;145(1):66–72 [DOI] [PubMed] [Google Scholar]
  • 5. Swaye PS, Fisher LD, Litwin P, Vignol PA, Judkins MP, et al.: Aneurysmal coronary artery disease. Circulation 983; 67(1):134–138 [DOI] [PubMed] [Google Scholar]
  • 6. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, et al.: Clinical significance of coronary arterial ectasia. Am J Cardiol 1976;37(2):217–222 [DOI] [PubMed] [Google Scholar]
  • 7. Swanton RH, Thomas ML, Coltart DJ, Jenkins BS, Webb‐Peploe MM, Williams BT: Coronary artery ectasia—a variant of occlusive coronary arteriosclerosis. Br Heart J 1978;40(4):393–400 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Befeler B, Aranda J, Embi A, Mullin F, El‐Sherif N, et al.: Coronary artery aneurysms. Study of their etiology, clinical course and effect on left ventricular function and prognosis. Am J Med 1977;62(4):597–607 [DOI] [PubMed] [Google Scholar]
  • 9. Principal Investigators of CASS and their Associates : National Heart, Lung, and Blood Institute Coronary Artery Surgery Study. Circulation 1981;63 (suppl II):I1–1 [PubMed] [Google Scholar]
  • 10. Schoenhagen P, Ziada KM, Vince DG, Nissen SE, Tuzcu EM: Arterial remodeling and coronary artery disease: The concept of “dilated” versus “obstructive” coronary atherosclerosis. J Am Coll Cardiol 2001;38(2): 297–306 [DOI] [PubMed] [Google Scholar]
  • 11. Kajinami K, Kasashima S, Oda Y, Koizumi J, Katsuda S, et al.: Coronary ectasia in familial hypercholesterolemia: Histopathologic study regarding matrix metalloproteinases. Mod Pathol 1999; 12(12):1174–1180 [PubMed] [Google Scholar]
  • 12. Akdemir R, Ozhan H, Gunduz H, Erbilen E, Yazici M, et al.: HLA‐DR B1 and DQ B1 polymorphisms in patients with coronary artery ectasia. Acta Cardiol 2004;59:499–502 [DOI] [PubMed] [Google Scholar]
  • 13. Lamblin N, Bauters C, Hermant X, Lablanche JM, Helbecque N, et al.: Polymorphisms in the promoter regions of MMP‐2, MMP‐3, MMP‐9 and MMP‐12 genes as determinants of aneurysmal coronary artery disease. J Am Coll Cardiol 2002;40(1):43–48 [DOI] [PubMed] [Google Scholar]
  • 14. Takeuchi K, Yamamoto K, Kataoka S, Kakihara T, Tanaka A, et al.: High incidence of angiotensin I‐converting enzyme genotype II in Kawasaki disease patients with coronary aneurysm. Eur J Pediatr 1997;156(4):266–268 [DOI] [PubMed] [Google Scholar]
  • 15. Buikema H, Pinto YM, Rooks G, Grandjean JG, Schukert H, et al.: The deletion polymorphism of the angiotensin‐converting enzyme gene is related to phenotypic differences in human arteries. Eur Heart J 1996;17: 787–794 [DOI] [PubMed] [Google Scholar]
  • 16. Daugherty A, Manning MW, Cassis LA: Angiotensin II promotes atherosclerotic lesions and aneurysms in apolipoprotein E‐deficient mice. J Clin Invest 2000;105:1605–1612 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17. Finkelstein A, Michowitz Y, Abashidze A, Miller H, Keren G, et al.: Temporal association between circulating proteolytic, inflammatory and neurohormonal markers in patients with coronary ectasia. Atherosclerosis 2005;179(2):353–359 [DOI] [PubMed] [Google Scholar]
  • 18. Celik S, Erdogan T, Kasap H, Kaplan S, Durmus I, et al.: Carotid intima‐media thickness in patients with isolated coronary artery ectasia. Atherosclerosis In press, 2006; Epub ahead of print (PMID 16545387) [DOI] [PubMed] [Google Scholar]
  • 19. Tokgozoglu L, Ergene O, Kinay O, Nazli C, Hascelik G, et al.: Plasma interleukin‐6 levels are increased in coronary artery ectasia. Acta Cardiol 2004;59(5):515–519 [DOI] [PubMed] [Google Scholar]
  • 20. Bermudez PE, Palop LR, Martinez‐Luengas MI, Sanchez CR, Saez CP, et al.: Coronary ectasia: Prevalence and clinical and angiographic characteristics. Rev Esp Cardiol 2003;56(5):473–479 [DOI] [PubMed] [Google Scholar]
  • 21. Sayin T, Doven O, Berkalp B, Akyurek O, Gulec S, et al.: Exercise‐induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease. Int J Cardiol 2001;78(2):143–149 [DOI] [PubMed] [Google Scholar]
  • 22. Sanyal S, Caccavo N: Is nitroglycerin detrimental in patients with coronary artery ectasia? A case report. Tex Heart Inst J 1998;25(2):140–144 [PMC free article] [PubMed] [Google Scholar]
  • 23. Mrdovic I, Jozic T, Asanin M, Perunicic J, Ostojic M: Myocardial reinfarction in a patient with coronary ectasia. Cardiology 2004;102(1):32–34 [DOI] [PubMed] [Google Scholar]
  • 24. Rosenberg VD, Nepomnyashchikh LM: Pathomorphological peculiarities of coronary artery ectasias and their role in the pathogenesis of sudden cardiac death. Bull Exp Biol Med 2004;138(5):515–521 [DOI] [PubMed] [Google Scholar]
  • 25. Lahiri S, Sethi KK, Jain R, Sawhney JPS, Chopra VK, et al.: Coronary ectasia: Prevalence, clinical and angiographic characteristics (abstr). Indian Heart J 2002;54(5):D37 [Google Scholar]
  • 26. Huikuri HV, Mallon SM, Myerburg RJ: Cardiac arrest due to spontaneous coronary artery dissection in a patient with coronary ectasia—a case report. Angiology 1991;42(2):148–151 [DOI] [PubMed] [Google Scholar]
  • 27. Nyamu P, Ajit MS, Joseph PK, Venkitachalam L, Sugirtham NA: The prevalence and clinical profile of angiographic coronary ectasia. Asian Cardiovasc Thorac Ann 2003;11(2):122–126 [DOI] [PubMed] [Google Scholar]
  • 28. Androulakis AE, Andrikopoulos GK, Kartalis AN, Stougiannos PN, Katsaros AA, et al.: Relation of coronary artery ectasia to diabetes mellitus. Am J Cardiol 2004;93(9):1165–1167 [DOI] [PubMed] [Google Scholar]
  • 29. Williams SB, Cusco JA, Roddy MA, Johnstone MT, Creager MA: Impaired nitric oxide‐mediated vasodilation in patients with non‐insulin‐dependent diabetes mellitus. J Am Coll Cardiol 1996;27(3):567–574 [DOI] [PubMed] [Google Scholar]
  • 30. Demopoulos V, Dalampiras P, Sifaki M, Olympios C, Foussas S, et al.: Isolated coronary artery ectasia does not have a benign long‐term prognosis (abstr). J Am Coll Cardiol 1999;33(suppl A):1128–1140 [Google Scholar]
  • 31. Sadr‐Ameli M, Sharifi M: The natural history of ectatic coronary artery disease. Iranian Heart J 2001;2(1):12–16 [Google Scholar]
  • 32. Papadakis MC, Manginas A, Cotileas P, Demopoulos V, Voudris V, et al.: Documentation of slow coronary flow by the TIMI frame count in patients with coronary ectasia. Am J Cardiol 2001;88(9):1030–1032 [DOI] [PubMed] [Google Scholar]
  • 33. Gulec S, Atmaca Y, Kilickap M, Akyurek O, Aras O, et al.: Angiographic assessment of myocardial perfusion in patients with isolated coronary artery ectasia. Am J Cardiol 2003;91(8):996–999 [DOI] [PubMed] [Google Scholar]
  • 34. Harikrishnan S, Sunder KR, Tharakan J, Titus T, Bhat A, et al.: Coronary artery ectasia: Angiographic, clinical profile and follow‐up. Indian Heart J 2000;52(5):547–553 [PubMed] [Google Scholar]
  • 35. Ochiai M, Yamaguchi T, Taguchi J, Ohno M, Yoshimura H, et al.: Angio‐ plasty of stenoses adjacent to aneurysmal coronary artery disease. Jpn Heart J 1990;31(6):749–757 [DOI] [PubMed] [Google Scholar]
  • 36. Yip HK, Chen MC, Wu CJ, Hang CL, Hsieh KY, et al.: Clinical features and outcome of coronary artery aneurysm in patients with acute myocardial infarction undergoing a primary percutaneous coronary intervention. Cardiology 2002;98(3):132–140 [DOI] [PubMed] [Google Scholar]
  • 37. Bernard F, Revel F, Monsegu J, Duriez P, Langlade S, et al.: Coronary vessel ectasia: Coronary artery disease with a high thromboembolic risk. Ann Cardiol Angiol 1998;47(3):160–164 [PubMed] [Google Scholar]
  • 38. Urasawa K, Inoue N, Yokota T, Oyama N, Sakai H, et al.: Mural thrombus in an ectatic right coronary artery caused acute myocardial infarction at downstream coronary artery. Int Heart J 2005;46(2):313–316 [DOI] [PubMed] [Google Scholar]
  • 39. Hart JJ, Joslin CG: Coronary artery ectasia. Kans Med 1998;98(3):6–9 [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES