Coronary aneurysms

Coronary aneurysms

Coronary aneurysms can be defined as localized dilatation of the coronary artery of more than 1.5 times (some suggest higher ratio) compared to the adjacent coronary segment. Etiology of coronary aneurysms could be atheroscleroitc, congenital (age less than 30 years), Kawasaki disease, connective tissue diseases like polyarteritis nodosa, Ehlers-Danlos syndrome and Marfan syndrome, arteritis like syphilitic or Takayasu’s and iatrogenic following drug eluting stent (DES) implantation or vascular trauma. Potential problems of coronary aneurysms could be due to associated atherosclerosis which is seen in 60-70%, distal embolization of thrombus formed due to the abnormal flow pattern in the aneurysm or due to the chance of rupture leading to cardiac tamponade.

Treatment of coronary aneurysm are certainly needed if there is associated coronary artery disease or if they cause acute coronary syndrome. Covered stents, multiple stents, stent assisted coil embolization (stenting of parent vessel to isolate the aneurysm followed by delivery of micro coils within the aneurysm) and anticoagulation are the various strategies. Aneurysms of left main are difficult to tackle surgically and may need reverse cardioplegia. It may be necessary to divide the pulmonary artery to reach the left main in some cases. Exclusion of aneurysm, ligation of the vessel and putting a graft beyond the point of ligation is a surgical option. Covered stents are another option which can be placed percutaneously for treatment of coronary aneurysms. Covered stents are usually have polytetrafluoroethylene (PTFE) covering. Another method of producing covered stent is to suture a saphenous vein to the stent. But then it becomes quite bulky and difficult to cross the lesion.