Ectatic Coronary Arteries: Diversity at Its Finest

Abstract

Coronary artery ectasia (CAE) is an entity causing inappropriate dilatation of the coronary tree, that is angiographically defined, albeit arbitrarily, by the diameter of the ectatic segment being more than 1.5 times larger in comparison with an adjacent healthy reference segment. Although the causative mechanisms are poorly understood, atherosclerosis is greatly implicated in the causation of CAE. Clinical, angiographic, and therapeutic features have been puzzling clinicians. We illustrate three different angiographic subsets, co-existing with myocardial bridge/coronary slow flow and diversely presenting as asymptomatic, pauci, and frankly symptomatic with stable and acute coronary syndrome. These cases illuminate the diversity of CAE's clinical and angiographic presentations and pathologic progression, shedding light on this medical condition and its implications.

Keywords: coronary angiography; coronary artery; coronary ectasia; coronary slow flow; ectatic coronary vessel; myocardial bridging.

Figure 1. Multiple ectatic coronary segments. (A) The proximal part of the left anterior descending artery and (B) the proximal left circumflex and its obtuse marginal branch with sluggish intraluminal flow.

Figure 2. Moderately ectatic left anterior descending artery in its proximal and middle parts with a proximal swirling flow and a distal myocardial bridging.

Figure 3. (A) Fusiform ectasia of the middle segment of left circumflex artery (white arrow). (B) Diffuse mild ectasia of the right coronary artery.