Coronary artery ectasia: a rare cause of acute coronary syndrome

Abstract

Coronary artery ectasia (CAE) is defined as a localised or diffuse dilatation of coronary artery lumen more than 1.5 times that of an adjacent normal segment. CAE may present with or without functionally significant stenosis. Such patients may manifest with stable angina or with acute coronary syndrome. Ectasia may serve as a nidus for thrombus formation with likelihood of distal embolisation or it may lead to dissection or spasm. This condition presents a challenge for an interventionist. Should we intervene or manage it medically. We describe a case of CAE where all the vessels were diffusely ectatic with variable degree of stenosis. In brief we discuss the causes and management issues in ectasia.

Keywords: cardiovascular medicine; interventional cardiology; ischaemic heart disease.

Figure 1

Twelve-lead ECG showing ST segment elevation in II, III, avF and ST segment depression in V1–V4.

Figure 2

Right anterior oblique (RAO) cranial view showing ectasia in proximal to distal segment of left anterior descending coronary artery (LAD) with mild stenosis in proximal segment and slow flow in distal segment.

Figure 3

Right anterior oblique (RAO) caudal view of the left system showing diffuse ectasia of left circumflex coronary artery (LCX). LAD, left anterior descending coronary artery.

Figure 4

Left anterior oblique (LAO) cranial view of the right coronary artery (RCA) showing diffuse ectasia with severe stenosis in the proximal segment with evidence of thrombus, mild stenosis in mid-segment and severe stenosis at the origin of posterior descending artery (PDA) and proximal posterolateral artery (PLV, posterior left ventricular artery).