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. 2009 Feb 3;21(3):157–160. doi: 10.1002/clc.4960210304

Current knowledge and significance of coronary artery ectasia: A chronologic review of the literature, recommendations for treatment, possible etiologies, and future considerations

Vincent L Sorrell 1,✉, Michael J Davis 2, Alfred A Bove 3
PMCID: PMC6656175  PMID: 9541758

Abstract

Coronary artery ectasia is the abnormal enlargement of the coronary artery. The prognosis, treatment, and etiology of this disease remain an enigma. There is some evidence to suggest that the incidence of ectasia is increasing, and therefore understanding of this entity needs to improve. This article reviews the current literature on coronary artery ectasia and summarizes the findings. A treatment plan that targets each of the suggested clinical complications is provided. Using multiple indirect observations and current understanding of endothelium‐derived relaxation factor, a possible etiology that implicates overstimulation of endogenous nitric oxide is provided. Current literature suggests that ectatic coronary arteries, even without the presence of coronary stenosis, are subject to thrombus formation, vasospasm, and spontaneous dissection. Newer subgroups of ectasia are arising with the use of multiple interventional devices to dilate coronary artery stenosis. By design, these destroy the media of the coronary artery, and it is not clear whether these “iatrogenic” ectatic arteries are subject to the same complications as “idiopathic” coronary artery ectasia. Further investigation is necessary to help define the benefit of the proposed treatment regimen, to clarify the prognosis of these newer groups of “iatrogenic” ectasia, and to confirm or disprove the hypothesis targeting nitric oxide as an etiologic factor.

Keywords: acetylcholine, Agent Orange, aneurysm, ateriomegaly, atherectomy, coronary artery, ectasia, herbicide, nitric oxide, paraquat, vasospasm

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References

  • 1. Bourgon A in Biblioth Med 1812; 37: 183, [Google Scholar]; cited in Packard M, Weehsler HF: Aneurysm of the coronary arteries. Arch Intern Med 1929; 43: 1–14 [Google Scholar]
  • 2. Packard M, Wechsler HF: Aneurysm of coronary arteries. Arch Intern Med 1929; 43: 1–14 [Google Scholar]
  • 3. Bjork L: Ectasia of the coronary arteries. Radiology 1966; 87: 33–34 [DOI] [PubMed] [Google Scholar]
  • 4. Markis JE, Joffe CD, Cohn PF, Feen DJ, Herman MV, Gorlin R: Clinical significance of coronary artery ectasia. Am J Cardiol 1976; 37: 217–222 [DOI] [PubMed] [Google Scholar]
  • 5. Bruschke AVG, Proudfit WL, Sones FM: Progressive study of 590 consecutive nonsurgical cases of coronary disease followed 5‐9 years. I. Arteriographic correlations. Circulation 1973; 47: 1147–1153 [DOI] [PubMed] [Google Scholar]
  • 6. 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: 393–400 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Hartnell GG, Parnell BM, Pridie RB: Coronary artery ectasia—its prevalence and clinical significance in 4993 patients. Br Heart J 1985; 54: 392–395 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Suzuki H, Takeyama Y, Hamazaki Y, Namiki A, Koba S, Matsubara H, Hiroshige J, Murakami M, Katagiri T: Coronary spasm in patients with coronary ectasia. Cathet Cardiovasc Diagn 1994; 32: 1–7 [DOI] [PubMed] [Google Scholar]
  • 9. Bove AA, Vlietstra RE: Spasm in ectatic coronary arteries. Mayo Clin Proc 1985; 60: 822–826 [DOI] [PubMed] [Google Scholar]
  • 10. Perlman PE, Ridgeway NA: Thrombus and anticoagulation therapy in coronary ectasia. Clin Cardiol 1989; 12: 541–542 [DOI] [PubMed] [Google Scholar]
  • 11. 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; February: 148–151 [DOI] [PubMed]
  • 12. Hill JA, Margolis JR, Feldman RL, Conti CR, Pepine CJ: Coronary arterial aneurysm formation after balloon angioplasty. Am J Cardiol 1983; 52: 261–264 [DOI] [PubMed] [Google Scholar]
  • 13. De Cesare NB, Popma JL, Holmes DR, Dick RJ, Whitlow PL, King SB, Pinkerton CA, Keriakes DJ, Topol EJ, Haudenschild CC, Ellis SG: Clinical, angiographic and histologic correlates of ectasia after directional coronary atherectomy. Am J Cardiol 1992; 69: 314–319 [DOI] [PubMed] [Google Scholar]
  • 14. Sorrell VL, Davis MJ, Bove AA: Origins of coronary artery ectasia (signed commentary). Lancet 1996; 347: 136–137 [DOI] [PubMed] [Google Scholar]
  • 15. England JF: Herbicides and coronary artery ectasia (letter). M J Aust 1981; 2: 140 [DOI] [PubMed] [Google Scholar]
  • 16. Vanhoutte PM: Endothelium and control of vascular function. Hypertension 1989; 13: 658–667 [DOI] [PubMed] [Google Scholar]
  • 17. Lange RL, Reid MS, Tresch DD, Keelan MH, Bernhard VM, Coolidge G: Nonatheromatous ischemic heart disease following withdrawal from chronic industrial nitroglycerin exposure. Circulation 1972; XLVI: 666–678 [DOI] [PubMed] [Google Scholar]
  • 18. Carmichael P, Lieben J: Sudden death in explosives workers. Arch Environ Health (Chicago) 1963; 7: 50–65 [DOI] [PubMed] [Google Scholar]
  • 19. Proudfit WL, Shiley EK, Sones MF: Selective cine coronary arteriography: Correlation with clinical findings in 1000 patients. Circulation 1966; 33: 901–910 [DOI] [PubMed] [Google Scholar]
  • 20. England JF: Herbicides and coronary artery ectasia (letter). M J Aust 1981; 68: 260 [DOI] [PubMed] [Google Scholar]
  • 21. International Agency for Research on Cancer Report 1978. (June); 78: 1–47 [Google Scholar]
  • 22. Dockery P: Respiratory effects of particles—health effect studies. Ann Rev Pub Health 1994; 15: 113–132 [Google Scholar]

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