[Coronary aneurysms not associated to stenosis of coronary arteries. Conservative treatment and evolution in six patients]

Abstract

Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1-2% per year. The most frequent cause is atherosclerosis and, in that case, they are always associated to stenosis of coronary arteries. We reviewed the coronary angiographic studies performed in the past seven years and we identified six patients that were admitted with an acute coronary syndrome, whose angiographic studies showed the presence of aneurysms in, at least, one of the coronary arteries. In these patients, we found no relation between aneurysms and distal or proximal stenosis. Although there was no angiographic evidence of classical coronary atherosclerosis, we think that atherosclerotic disease could have been the etiological cause, due to injury of the endothelium and media by deposits of lipids, smooth muscle cells, collagen, macrophages, and T-lymphocytes that would have damaged the adventitia layers of the vessel wall, stimulating "vasa-vasorum" neovascularization. The evolution of coronary aneurysms without associated stenosis in the same coronary artery and without another potentially treatable cause is unknown. Due to the limited literature regarding this issue and, taking into account our experience, we feel that, in these cases, medical treatment might be a good option as we detected no major cardiac events in any patient at mid and long-term follow up.