Coronary ectasia Angiographic finding of abnormal coronary dilatation

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. Circulation 1983; 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, Bhushan. V, Kane JP et al. Increased prevalence of coronary ectasia in heterozygous familial hypercholesterolemia. Circulation 1995; 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