Coronary artery aneurysm

Coronary Angiography

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General Principles

Overview

Historical Perspective

Contraindications

Appropriate Use Criteria for Revascularization

Complications

Technique

Film Quality

Anatomy & Projection Angles

Normal Anatomy

Coronary arteries
Dominance
Right System
Left System

Left Main
Left Anterior Descending
Circumflex
Median Ramus

Anatomic Variants

Separate Ostia
Anomalous Origins

Case Example
Fistula

Projection Angles

Standard Views
Left Coronary Artery
Right Coronary Artery

Epicardial Flow & Myocardial Perfusion

Epicardial Flow

TIMI Frame Count

TIMI Flow Grade

TIMI Grade 0 Flow
TIMI Grade 1 Flow
TIMI Grade 2 Flow
TIMI Grade 3 Flow
TIMI Grade 4 Flow
Pulsatile Flow
Deceleration

Myocardial Perfusion

TIMI Myocardial Perfusion Grade

TMP Grade 0
TMP Grade 0.5
TMP Grade 1
TMP Grade 2
TMP Grade 3

Lesion Complexity

ACC/AHA Lesion-Specific Classification of the Primary Target Stenosis

Preprocedural Lesion Morphology

Eccentricity
Irregularity

Ulceration
Intimal Flap
Aneurysm
Sawtooth Pattern
Length
Ostial location
Angulation
Proximal tortuosity
Degenerated SVG
Calcification
Total occlusion
Coronary Artery Thrombus

TIMI Thrombus Grade
TIMI Thrombus Grade 0
TIMI Thrombus Grade 1
TIMI Thrombus Grade 2
TIMI Thrombus Grade 3
TIMI Thrombus Grade 4
TIMI Thrombus Grade 5
TIMI Thrombus Grade 6

Lesion Morphology

Quantitative Coronary Angiography
Definitions of Preprocedural Lesion Morphology
Irregular Lesion
Disease Extent
Arterial Foreshortening
Infarct Related Artery
Restenosis
Degenerated SVG
Collaterals
Aneurysm
Bifurcation
Trifurcation
Ulceration

Left ventriculography

Technique
Quantification of LV Function
Quantification of Mitral Regurgitation

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. [3]

Synonyms and keywords: CAA, coronary artery ectasia

## Overview

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Coronary artery aneurysm is an abnormal dilatation of a coronary artery segment over 1.5 times the diameter of normal adjacent segment.[1] An aneurysm can be classified as either saccular (wider than it is long) or fusiform (elongated). Coronary artery aneurysm must be differentiated from coronary artery ectasia; in fact, coronary artery ectasia is a localized arterial dilatation that is graded according to the size of the dilatation in comparison to the normal artery diameter located anywhere in the culprit artery. A coronary artery ectasia is considered as an aneurysm when the coronary artery dilatation is 1.5 times the normal artery diameter located anywhere in the culprit artery.

## Grading System

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A localized arterial widening (dilatation) that usually manifests itself as a bulge. Its presence may lead to weakening of the wall and eventual rupture.

### Grade 0

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None – no ectasia present.

### Grade 1

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Ectasia – visual assessment of ectasia >1 & < 1.5 times the normal artery diameter located anywhere in the culprit artery.

### Grade 2

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Aneurysm – visual assessment of an aneurysm > 1.5 times the normal artery diameter located anywhere in the culprit artery.

Shown below are an animated image and a static image depicting an aneurysm in the left coronary artery. Outlined in yellow in the image on the right is the localized aneurysm which is a dilatation of the coronary artery segment >1.5 times the diameter of the adjacent segments on the LCA.

## Causes

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* Atherosclerosis[2]
* Collagen vascular diseases
* Coronary catheterization
* Kawasaki disease[3]
* Vasculitides

## Epidemiology and Demographics

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* The incidence of CAA ranges widely between 0.3-5.3% within angiographic series with a mean incidence of 1.65%.[4] A highest incidence of 10-12% was reported in a study from India. Perhaps reflecting a specific genetic and/or environmental predisposition.[5]

* CAA most commonly occurs in right coronary artery accounting for 40-87% followed by left anterior descending artery and left circumflex artery.[6][7]

* CAA of left main artery or triple-vessel CAA are rare.[6]

## Prognosis

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Coronary artery aneurysm has a good prognosis.[8]

## Diagnosis

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It is often found coincidentally on coronary angiography.[8]

## References

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1. ↑ Jarcho S (1969). "Bougon on coronary aneurysm (1812)". Am J Cardiol. 24 (4): 551–3. PMID 4897732.
2. ↑ Nichols L, Lagana S, Parwani A (2008). "Coronary artery aneurysm: a review and hypothesis regarding etiology". Arch. Pathol. Lab. Med. 132 (5): 823–8. PMID 18466032. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
3. ↑ Fukazawa R, Ikegam E, Watanabe M; et al. (2007). "Coronary artery aneurysm induced by Kawasaki disease in children show features typical senescence". Circ. J. 71 (5): 709–15. PMID 17456996. Unknown parameter `|month=` ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ Hartnell GG, Parnell BM, Pridie RB (1985). "Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients". Br Heart J. 54 (4): 392–5. PMC 481917. PMID 4052280.CS1 maint: Multiple names: authors list (link) CS1 maint: PMC format (link)
5. ↑ Sharma SN, Kaul U, Sharma S, Wasir HS, Manchanda SC, Bahl VK; et al. (1990). "Coronary arteriographic profile in young and old Indian patients with ischaemic heart disease: a comparative study". Indian Heart J. 42 (5): 365–9. PMID 2086442.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ 6.0 6.1 Villines TC, Avedissian LS, Elgin EE (2005). "Diffuse nonatherosclerotic coronary aneurysms: an unusual cause of sudden death in a young male and a literature review". Cardiol Rev. 13 (6): 309–11. PMID 16230889.CS1 maint: Multiple names: authors list (link)
7. ↑ Swaye PS, Fisher LD, Litwin P, Vignola PA, Judkins MP, Kemp HG; et al. (1983). "Aneurysmal coronary artery disease". Circulation. 67 (1): 134–8. PMID 6847792.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
8. ↑ 8.0 8.1 Pahlavan PS, Niroomand F (2006). "Coronary artery aneurysm: a review". Clin Cardiol. 29 (10): 439–43. PMID 17063947. Unknown parameter `|month=` ignored (help)

* v
* t
* e

Cardiovascular disease (heart)

Ischaemic|

| Coronary disease|

* Coronary artery disease (CAD)
* Coronary artery aneurysm
* Spontaneous coronary artery dissection (SCAD)
* Coronary thrombosis
* Coronary vasospasm
* Myocardial bridge

|

Active ischemia|

* Angina pectoris
* Prinzmetal's angina
* Stable angina
* Acute coronary syndrome
* Myocardial infarction
* Unstable angina

Sequelae|

* hours
* Hibernating myocardium
* Myocardial stunning
* days
* Myocardial rupture
* weeks
* Aneurysm of heart / Ventricular aneurysm
* Dressler syndrome

Layers|

| Pericardium|

* Pericarditis
* Acute
* Chronic / Constrictive
* Pericardial effusion
* Cardiac tamponade
* Hemopericardium

|

Myocardium|

* Myocarditis
* Chagas disease
* Cardiomyopathy
* Dilated
* Alcoholic
* Hypertrophic
* Tachycardia-induced
* Restrictive
* Loeffler endocarditis
* Cardiac amyloidosis
* Endocardial fibroelastosis
* Arrhythmogenic right ventricular dysplasia

Endocardium /
valves|

| Endocarditis|

* infective endocarditis
* Subacute bacterial endocarditis
* non-infective endocarditis
* Libman–Sacks endocarditis
* Nonbacterial thrombotic endocarditis

|

Valves|

* mitral
* regurgitation
* prolapse
* stenosis
* aortic
* stenosis
* insufficiency
* tricuspid
* stenosis
* insufficiency
* pulmonary
* stenosis
* insufficiency

Conduction /
arrhythmia|

| Bradycardia|

* Sinus bradycardia
* Sick sinus syndrome
* Heart block: Sinoatrial
* AV
* 1°
* 2°
* 3°
* Intraventricular
* Bundle branch block
* Right
* Left
* Left anterior fascicle
* Left posterior fascicle
* Bifascicular
* Trifascicular
* Adams–Stokes syndrome

|

Tachycardia
(paroxysmal and sinus)|

| Supraventricular|

* Atrial
* Multifocal
* Junctional
* AV nodal reentrant
* Junctional ectopic

|

Ventricular|

* Accelerated idioventricular rhythm
* Catecholaminergic polymorphic
* Torsades de pointes

Premature contraction|

* Atrial
* Junctional
* Ventricular

Pre-excitation syndrome|

* Lown–Ganong–Levine
* Wolff–Parkinson–White

Flutter / fibrillation|

* Atrial flutter
* Ventricular flutter
* Atrial fibrillation
* Familial
* Ventricular fibrillation

Pacemaker|

* Ectopic pacemaker / Ectopic beat
* Multifocal atrial tachycardia
* Pacemaker syndrome
* Parasystole
* Wandering atrial pacemaker

Long QT syndrome|

* Andersen–Tawil
* Jervell and Lange-Nielsen
* Romano–Ward

Cardiac arrest|

* Sudden cardiac death
* Asystole
* Pulseless electrical activity
* Sinoatrial arrest

Other / ungrouped|

* hexaxial reference system
* Right axis deviation
* Left axis deviation
* QT
* Short QT syndrome
* T
* T wave alternans
* ST
* Osborn wave
* ST elevation
* ST depression
* Strain pattern

Cardiomegaly|

* Ventricular hypertrophy
* Left
* Right / Cor pulmonale
* Atrial enlargement
* Left
* Right
* Athletic heart syndrome

Other|

* Cardiac fibrosis
* Heart failure
* Diastolic heart failure
* Cardiac asthma
* Rheumatic fever

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