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Isolated coronary artery ectasia presenting as inferior-posterior STEMI—a case-based state-of-the-art review of the current literature

Adrian Giucă
Adrian Giucă
, 
Alexandru Rocsoreanu
Alexandru Rocsoreanu
, 
Marilena Şerban
Marilena Şerban
, 
Monica Roşca
Monica Roşca
, 
Maria Iancu
Maria Iancu
, 
Andrei Carp
Andrei Carp
, 
Dan Deleanu
Dan Deleanu
 e 
Marin Postu
Marin Postu
   | 26 dic 2023
Romanian Journal of Cardiology's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
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Article Category: Review
Pubblicato online: 26 dic 2023
Pagine: 147 - 160
DOI: https://doi.org/10.2478/rjc-2023-0025
Parole chiave
© 2023 Adrian Giucă et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

Resting electrocardiogram at admission. Sinus rhythm, 70 bpm; QRS axis, +60°; ST segment elevation DII, DIII, aVF, V7–V9 with reciprocal ST segment depression in V1–V3, aVL.
Resting electrocardiogram at admission. Sinus rhythm, 70 bpm; QRS axis, +60°; ST segment elevation DII, DIII, aVF, V7–V9 with reciprocal ST segment depression in V1–V3, aVL.

Figure 2.

Left anterior oblique projection of the right coronary artery. Significantly dilated right coronary artery (RCA) on its entire length, seen in left anterior oblique projection. Arrows indicate high quantity of thrombotic material in the mid-distal RCA.
Left anterior oblique projection of the right coronary artery. Significantly dilated right coronary artery (RCA) on its entire length, seen in left anterior oblique projection. Arrows indicate high quantity of thrombotic material in the mid-distal RCA.

Figure 3.

Cranial right anterior oblique projection of the left coronary artery. Optimal projection of the left anterior descending artery (LAD) showing an ectatic vessel, with a maximum diameter of 7.4 mm in the proximal segment.
Cranial right anterior oblique projection of the left coronary artery. Optimal projection of the left anterior descending artery (LAD) showing an ectatic vessel, with a maximum diameter of 7.4 mm in the proximal segment.

Figure 4.

Caudal left anterior oblique projection of the left coronary artery. “Spyder” projection shows ectasia of the left main coronary artery (maximum diameter of 10.3 mm in the mid-distal portion) and left circumflex (maximum diameter of 8.5 mm in the proximity of the ostium).
Caudal left anterior oblique projection of the left coronary artery. “Spyder” projection shows ectasia of the left main coronary artery (maximum diameter of 10.3 mm in the mid-distal portion) and left circumflex (maximum diameter of 8.5 mm in the proximity of the ostium).

Figure 5.

Left anterior oblique projection of the right coronary artery—1 month later. One month later, there is no evidence of thrombus in the right coronary artery, and there is a moderate stenosis in the distal segment.
Left anterior oblique projection of the right coronary artery—1 month later. One month later, there is no evidence of thrombus in the right coronary artery, and there is a moderate stenosis in the distal segment.

Figure 6.

Cranial right anterior oblique projection of the left anterior descending artery—1 month later. In this projection, the left anterior descending artery can be seen, with ectasia on the entire length and a lack of significant atherosclerosis.
Cranial right anterior oblique projection of the left anterior descending artery—1 month later. In this projection, the left anterior descending artery can be seen, with ectasia on the entire length and a lack of significant atherosclerosis.

Figure 7.

Postero-anterior caudal projection of the left coronary artery—1 month later. This view optimally projects the left main coronary artery (mid-distal segment) and the left circumflex, in which no significant atherosclerotic lesions are seen. Note also the diffuse ectasia present in both arteries.
Postero-anterior caudal projection of the left coronary artery—1 month later. This view optimally projects the left main coronary artery (mid-distal segment) and the left circumflex, in which no significant atherosclerotic lesions are seen. Note also the diffuse ectasia present in both arteries.

Coronary artery ectasia etiology. ANCA, antineutrophilic cytoplasmic antibody; KCNH1, member 1 of H subfamily of voltagegated potassium channel; ATG16L1, autophagia related 16 like 1; PCI, percutaneous coronary intervention

Etiology Frequency
Atherosclerosis 50% (19)
Smoking (19)
Arterial hypertension (19)
Congenital:

bicuspid aortic valve

aortic root dilation

ventricular septal defect

pulmonary stenosis

 		20%-30%(6, 19, 70)
Inflammatory diseases:

Kawasaki disease

Antineutrophilic cytoplasmic antibody (ANCA) vasculitis

Syphilitic aortitis

Polyarteritis nodosa

Takayasu disease

Systemic lupus erythematosus

Rheumatoid arthritis

 Connective tissue disorders:

Systemic sclerosis

Ehlers - Danlos

Marfan syndrome

 		10%-20% (10,19, 38, 67, 70, 71,136-140)
Cardiac lymphoma (141)
Infectious:

mycotic

Borreliosis

Chlamydia pneumoniae

 		(70, 142)
Hypertrophic cardiomyopathy (24)
Genetic factors:

genetic DD polymorphism of the angiotensin converting enzyme

abnormal lipoprotein metabolism associated with familiar hypercholesterolemia

member 1 of H subfamily of voltage-gated potassium channel (KCNH1)

mutation of autophagia related 16 like 1 (ATG16L1) gene

Matrix metalloproteinase allele 35A

 		(19, 30, 113, 143-145)
Cocaine usage (146)
Iatrogenic:

post-percutaneous coronary intervention (PCI)

coronary atherectomy

laser angioplasty

 		(25, 70)

Angiographic classification of coronary artery ectasia (modified after Markis JE, Cohn PF, Feen DJ et al. [4])

Type Characteristics
I Diffuse ectasia of 2 or 3 vessels
II Diffuse ectasia in 1 vessel and localized disease in another
III Diffuse ectasia of 1 vessel
IV Localized ectasia in 1 vessel
eISSN:
2734-6382
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Inglese
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Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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