Intracranial aneurysms, coronary aneurysms and descending aortic coarctation--unreported association

Rare association of coronary artery aneurysms with intra cranial aneurysms is reported. Also, association of abdominal aortic coarctation with intracranial aneurysms is rare. A 70-year-old female presented with subarachnoid hemorrhage secondary to rupture of intracranial aneurysm. On evaluation, she was found to have intracranial aneurysms in the vertebral and basilar artery, coronary aneurysms and descending thoracic aortic coarctation. This association is unreported.     

Frequency of coronary artery ectasia in patients undergoing surgery for ascending aortic aneurysms

We retrospectively studied the coronary arteriograms of 82 consecutive patients who underwent planned surgical repair of an ascending aorta aneurysm and an age-matched control group of 92 consecutive patients who underwent coronary angiography during the same time period. The present study examines the incidence of coronary artery ectasia in patients with aneurysms of the ascending aorta.     

Plasma interleukin-6 levels are increased in coronary artery ectasia

OBJECTIVE: Recent studies have suggested a cytokine-induced tissue inflammation in the pathogenesis of abdominal aortic aneurysms and it has been documented that circulating interleukin-6 (IL-6) levels in these patients are increased. The aim of this study was to investigate whether a similar association also exists for patients with coronary ectasia, which may also be regarded as an abnormal dilatation of the arterial system. METHODS AND RESULTS: The study group was composed of 43 patients with coronary ectasia and 48 patients with normal coronary arteries constituted the control group. Coronary diameters were measured by quantitative angiography. A coronary diameter index was defined for each segment as the coronary diameter divided by the body surface area (BSA). A coronary segment with a diameter index of more than 1.5 fold of the control group was defined as ectatic. Baseline characteristics of the two groups were similar. Serum IL-6 levels were significantly higher in patients with coronary ectasia (5.18 +/- 2.04 pg/ml vs. 4.13 +/- 0.5 pg/ml, p = 0.002). There was no significant correlation with the maximal diameter of the most dilated coronary segment and IL-6 levels in patients with coronary ectasia (r = 0.10, p = 0.50). CONCLUSIONS: Results of this study have demonstrated increased levels of circulating IL-6 in patients with coronary ectasia which might indicate a possible role of inflammatory processes. Absence of a significant correlation between the dimensions of the ectatic segments and IL-6 levels might be due to the narrower range of the diameters of the coronary arteries compared with the abdominal aorta.     

Exercise-induced myocardial ischemia in patients with coronary artery ectasia without obstructive coronary artery disease

BACKGROUND: Aetiology, clinical significance and treatment options for coronary artery ectasia/aneurysm is not clear. OBJECTIVE: We sought to determine whether exercise can induce coronary ischemia in patients with coronary artery ectasia/aneurysm without significant coronary stenosis. METHODS: Coronary artery ectasia was defined as 1.5-2-fold, aneurysm as >2-fold luminal dilatation of the adjacent normal segment. The study patients could have irregularities with ectatic coronaries but they did not have stenotic lesions >50% with visual assessment of two blinded observers. Patients having coronary artery ectasia or aneurysm with prior myocardial infarction, dilated cardiomyopathy, valvular heart disease, bundle branch block, significant ST-T changes were excluded. The control group was formed from a well matched population of 32 patients with normal coronary arteries who have not performed a treadmill test before coronary angiography. The study group underwent a symptom limited treadmill test if they did not have one before coronary angiogram, all control patients underwent treadmill test. RESULTS: Thirty-three patients with coronary artery ectasia/aneurysm (ranging from one to three vessels) but without significant stenosis were derived from 4470 cardiac catheterization procedures between January 1998 and July 2000. In the study group, 17 of the patients had positive treadmill tests with respect to five patients in the control group (P = 0.004). In subgroup analysis, diffuse ectasia/aneurysm (involving 2-3 vessels) was found to be strongly related with ischemia (P = 0.005) with respect to local disease. CONCLUSION: Coronary artery ectasia/aneurysm may lead to exercise induced ischemia, especially in the diffuse form.     

Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients

The incidence, angiographic features and natural history of discrete atherosclerotic coronary aneurysms were evaluated in 20 patients with 22 aneurysms (0.2% of 8,422 patients referred for coronary angiography). Fifteen aneurysms (68%) were in the left anterior descending, four (18%) in the circumflex, two (9%) in the right and one (5%) in the left main coronary artery. Aneurysm diameter ranged from 4 to 35 mm (mean 8); 95% of aneurysms were adjacent to a severe obstruction. Seventy-five percent of patients had severe triple vessel disease that included severe left main disease in 15%. Total obstruction of one or two arteries was present in 75%. In patients with wall motion abnormalities, 78% of the abnormalities were in the distribution of the aneurysm. Follow-up (range 1 to 90 months [mean 30]) was obtained in all 20 patients. There were two cardiac and two noncardiac deaths; 12 patients had coronary bypass surgery and of 16 survivors, 13 were angina-free. In conclusion, discrete coronary aneurysms are much less common than diffuse ectasia. Unlike ectasia, they are never found in arteries without severe stenosis, and are most common in the left anterior descending coronary artery. Associated coronary artery disease is more severe in patients with discrete aneurysms than in those with diffuse ectasia. Discrete coronary aneurysms do not appear to rupture, and their resection is not warranted.     

Coronary artery aneurysm associated with aneurysm of descending thoracic aorta: Case report

Coronary artery aneurysm is one of the rare abnormalities of cardiovascular system. Coronary artery aneurysm concomitant with abdominal, and ascending thoracic aortic aneurysm has been reported, but with descending thoracic aneurysm has not been reported. We are presenting a case of atherosclerotic left circumflex coronary artery aneurysm associated with aneurysm of descending thoracic aorta.     

Bifurcating aneurysm of the left main coronary artery involving left anterior descending and left circumflex arteries--a case report.

Coronary artery aneurysm is a rare coronary abnormality, usually diagnosed incidentally by coronary angiography. Major causes of coronary aneurysms include coronary ectasia, Kawasaki disease, and atherosclerosis. Most of the discrete coronary aneurysms are of atherosclerotic origin. The incidence of atherosclerotic coronary aneurysms is about 0.2%, and the left main coronary artery is the least frequently involved artery. Only a few cases of left main coronary artery aneurysm have been reported in the literature, and a left main coronary artery aneurysm involving the proximal segments of the left anterior descending and the left circumflex arteries has not been reported previously. The authors describe this finding in a man who presented with worsening exertional angina pectoris. Coronary angiography demonstrated an aneurysm of the distal left main coronary artery extending into the proximal segments of the left anterior descending and the left circumflex arteries. In addition, a significant flow-limiting atherosclerotic lesion was present in the proximal portion of the left anterior descending artery distal to the aneurysm.     

Nonsurgical management of left main coronary artery aneurysms: report of 2 cases and review of the literature

Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. Thrombosis within the aneurysm can lead to distal embolization and myocardial infarction. These lesions can extend into adjacent coronary branches and can occur in the presence or absence of obstructive coronary disease. Depending on the severity of coexistent coronary stenoses, patients with left main coronary artery aneurysms can be effectively managed either operatively or medically. We report the cases of 2 patients who were treated medically for large left main coronary aneurysms and concomitant right coronary artery ectasia.     

Coronary artery aneurysms: An unusual case report and a review of the literature

© 1993 Wiley-Liss, Inc. Coronary artery aneurysms (CAA) were first recognized in postmortem studies. More recently they have been recognized in antemortem and angiographic studies and are reported to occur at an incidence of 1-2%. Left main coronary aneurysms (LMCA) are extremely rare with an incidence of 0.1%. Most of the aneurysms discovered in these angiographic studies have been in patients with cardiac symptoms of angina or acute myocardial infarction who subsequently were found to have severe narrowing of the coronary arteries. Angiographic and clinical data of a patient with a large aneurysm of the left main coronary artery and with aneurysmal disease of the thoracic and abdominal aorta are presented along with a review of the literature. © 1993 Wiley-Liss, Inc.     

The diameters of the aorta and its major branches in patients with isolated coronary artery ectasia

We designed this study to evaluate the diameters of the aorta and its major branches in patients who had coronary ectasia. We assigned 80 patients (mean age, 57 +/- 11 yr) with isolated coronary artery ectasia to the study group and 25 patients (mean age, 54 +/- 10 yr) without structural or coronary arterial disease to the control group. All patients underwent coronary angiography and angiography of the aorta and its branches. We used computed quantitative angiography to measure the diameters of the coronary arteries, the aorta, and the major aortic branches. Within the study group, the diameter indices of the proximal portions of the right common iliac artery (P=0.041) and the left common iliac artery (P=0.035) were significantly larger than the diameter indices within the control group. The diameter indices of all other evaluated arteries were similar in both groups (all P >0.05).     

Giant coronary artery aneurysm in association with systemic arterial ectasia. A case report

Since the advent of coronary angiography, coronary artery aneurysm has been diagnosed with increased frequency. The etiology of coronary artery aneurysm is atherosclerosis in 50%, followed by other causes. In a 71-year-old man with previously documented abdominal aortic aneurysm of 6 cm diameter and ectasia of both left and right middle cerebral arteries, thoracic magnetic resonance imaging (MRI) demonstrated a large hollow para-cardiac mass (maximum diameter of 7 cm) lying in the anterior-lateral part of the atrio-ventricular sulcus. Coronary arteriography confirmed the aneurysmatic nature of the proximal tract of left anterior descending (LAD) artery lesion. Screening for laboratory signs of vasculitis was negative and other vascular and systemic diseases were excluded, suggesting an atherosclerotic aetiology of the aneurysm. In the absence of current cardiac symptoms, conservative management has been chosen and the patient is still well 2 years after presentation.     

Neurofibromatosis type 1 with basilar artery fusiform aneurysm manifesting Wallenberg's syndrome

A case of neurofibromatosis type 1 (NF1) manifesting Wallenberg's syndrome and fusiform aneurysm of the basilar artery is reported. The patient suddenly developed dysarthria, walking difficulty and sensory disturbance. Neurological examination suggested Wallenberg's syndrome and MR imaging confirmed an ischemic lesion at the left lateral medulla oblongata. Cerebral angiography revealed a fusiform aneurysm at the middle portion of the basilar artery. However, there was no occlusive change in either the posterior inferior cerebellar artery or the vertebral artery. The clinical and radiological features are discussed together with a review of NF1 cases with intracranial aneurysms in the literature.     

Magnetic resonance angiography is equivalent to X-ray coronary angiography for the evaluation of coronary arteries in Kawasaki disease

OBJECTIVES: The purpose of this study was to compare the results of magnetic resonance angiography (MRA) with X-ray coronary angiography (XCA) in a pediatric population. BACKGROUND: Coronary artery abnormalities in Kawasaki disease (KD) develop in about 15% to 25% of young patients, mostly in the form of aneurysms. METHODS: Thirteen patients (12 male), age three to eight years, were studied. The maximal diameter and length of the aneurysm were recorded. Coronary MRA was performed using a 1.5 T Philips Intera CV magnetic resonance scanner with an electrocardiographically triggered pulse sequence. It was a three-dimensional segmented k-space gradient-echo sequence (TE = 2.1 ms, TR = 7.5 ms, flip angle = 30 degrees, slice thickness = 1.5 mm) employing a T2-weighted preparation pre-pulse and a frequency selective fat-saturation pre-pulse. Data acquisition was performed in mid-diastole. All scans were carried out with the patient free breathing using a two-dimensional real-time navigator beam. All patients underwent XCA within a week. RESULTS: In six patients, aneurysms of the coronary arteries were identified, while coronary ectasia alone was present in the remaining seven patients. Magnetic resonance angiography and XCA diagnosis of coronary artery aneurysm agreed completely. Maximal aneurysm diameter and length and ectasia diameter by MRA and XCA were similar. No stenotic lesion was identified by either technique. CONCLUSIONS: In conclusion, MRA is a reliable diagnostic tool, equivalent to XCA for coronary artery aneurysm identification in patients with KD. Magnetic resonance angiography may prove to be of great value for the serial non-invasive evaluation of these patients.     

Noninvasive assessment of coronary artery ectasia using multidetector computed tomography

OBJECTIVES: The aim of this study is to determine the prevalence of coronary artery ectasia and its relationship to atheromatous changes in participants undergoing coronary computed tomography angiography. BACKGROUND: Coronary artery ectasia occasionally encountered on conventional coronary angiography is considered a manifestation of atherosclerosis. METHODS: Four hundred consecutive participants, 300 men (mean age 56 years) who underwent coronary computed tomography angiography were evaluated. Coronary artery ectasia was defined as an arterial segment with a diameter of at least 1.5 times the diameter of the adjacent normal coronary artery. The prevalence and location of coronary artery ectasia as well as concomitant atherosclerotic changes were evaluated. The association of coronary artery ectasia with coronary risk factors was also studied. RESULTS: Coronary artery ectasia was encountered in 31 participants (8%), 29 men. The right coronary artery was most commonly affected with ectasia (50%) and most participants had single-vessel involvement (74%). Twenty-six of 31 participants (84%) had coexisting atheromatous wall changes or insignificant coronary artery disease; four participants out of 31 (13%) had significant coronary artery disease. Coronary artery ectasia thrombosis was found only in one patient (3%). No apparent correlation was present between coronary artery ectasia and diabetes mellitus, hypertension, hyperlipidemia, smoking and family history of coronary artery disease. CONCLUSION: The prevalence of coronary artery ectasia in consecutive participants who underwent coronary computed tomography angiography is 8%. The right coronary artery was most commonly affected and most participants had single-vessel involvement. Coronary artery ectasia usually is associated with atheromatous changes, but not with significant coronary artery disease. Coronary artery ectasia thrombosis was a rare complication. No specific predisposing factors have been identified.     

An unusual case of bilateral coronary artery aneurysms and aortic aneurysms complicated by stenotic lesions

A 71-year-old Japanese woman presented with a chief complaint of throbbing sensations in the abdomen. When she was 16 years old, she was exposed to atomic radiation since she was 1.2 km away from the drop zone of the Nagasaki atomic bomb. Abdominal CT performed at the age of 61 revealed the presence of localized calcification below the renal artery, together with abdominal aortic aneurysms measuring 4.9 cm in maximum diameter. Since the abdominal aortic aneurysms enlarged in May 2000, the patient was admitted to our department for further examinations and treatment on July 7. Although the patient did not complain of thoracic symptoms, cardiac catheterization revealed the presence of multiple coronary artery aneurysms and severe stenosis in the main trunk of the left coronary artery and proximal regions of the right coronary artery, together with a complicated collateral circulation course. Coronary artery aneurysms were localized similar to the abdominal aortic aneurysms, and were complicated by severe calcification and obstructive lesions. Coronary arterial bypass grafting was performed after the severity of the coronary artery aneurysms was morphologically evaluated. The course of the abdominal aortic aneurysms was followed without surgical treatment. Although the etiology of the aneurysm formation in this patient was investigated, it remained unclear.     

Saccular coronary aneurysms: angiographic and clinical profile and follow-up of 22 cases

Saccular coronary aneurysms are defined as aneurysms with the transverse dimension at least 1.5 times the longitudinal dimension. Out of 3,200 coronary angiograms reviewed, there were 22 patients (20 males) with saccular coronary aneurysms (totalling 25 aneurysms). The morphology of the aneurysms, the extent and severity of associated coronary lesions, the clinical profile and follow-up data of these patients were analysed. Aneurysms were located in left main coronary artery 3 (12%), left anterior descending coronary artery 13 (52%), right coronary artery 5 (20%) and left circumflex 4 (16%). There were 5 large aneurysms (> 15 mm in diameter) (1 in left main coronary artery, 2 each in right coronary artery and left anterior descending coronary artery) averaging 32 mm in size. Fifteen aneurysms had significant coronary artery stenosis located proximal to it, supporting the theory of post-stenotic dilatation as the aetiology of aneurysm formation. Two patients had associated muscle bridges distal to the aneurysm; 20 had atherosclerotic coronary artery disease and one had coronary artery ectasia. Five patients were lost to follow-up, which ranged from 1 year to 19 years (mean 5.3 +/- 4.1 years). No patient had history suggestive of rupture of the aneurysm on follow-up. Two patients had myocardial infarction in the territory of the vessel with the aneurysm. Rest of the patients were in NYHA class I/II. One large right coronary artery aneurysm was subjected to aneurysmectomy due to symptoms of tricuspid valve obstruction. One left main coronary artery aneurysm measuring 12 mm, on follow-up of 19 years increased in size to 45 mm, in addition the patient developed a right coronary artery aneurysm. Coronary risk factor profiles in the 20 patients with atherosclerotic coronary artery disease and aneurysms were similar to age- and sex-matched control population with atherosclerotic coronary artery disease without aneurysms.     

Stent-graft treatment of infected aortic and arterial aneurysms.

PURPOSE: To evaluate the feasibility and effectiveness of endovascular stent-graft repair of infected aortic and arterial aneurysms. METHODS: Eight patients (5 men; mean age 56.6 years, range 30-85) with infected saccular aneurysms in the brachiocephalic artery (n=1), proximal descending thoracic aorta (n=1), infrarenal abdominal aorta (n=3), common iliac artery (n=1), and common femoral artery (n=2) were treated with stent-graft placement and intravenous antibiotic treatment for at least 6 weeks followed by case-specific administration of oral suppressive antibiotics. All patients were considered to be in the high-surgical-risk group. RESULTS: Exclusion of the infected aneurysm was successful in all patients. However, 2 patients died within 30 days of uncontrolled sepsis, and 1 patient died at 6 months after rupture of a persistently infected aneurysm (37% mortality rate). Over a follow-up that ranged to 8 years, the 5 survivors showed complete resolution of the infected aneurysms; no stent-graft infection was observed during follow-up. CONCLUSION: The acceptable technical and clinical success of endovascular aneurysm repair makes this a promising treatment for infected aortic and arterial aneurysms. However, it is crucial that the infection is treated adequately prior to stent-graft placement.     

National Adherence to Medical Management of Aortic Aneurysms

ObjectivesThe purpose of this study was to describe levels of adherence to guideline-based medical management in patients with aortic aneurysms, using an analogous population with coronary artery disease as a comparator. Adherence among those with aortic aneurysms has never been studied.MethodsAdult patients with an aortic aneurysm or coronary artery disease diagnosed between 2004 and 2018 in the Optum Clinformatics deidentified Datamart were queried. Aneurysms were subclassified as thoracic, abdominal, or both. Receipt of an antihypertensive or antihyperlipidemic was determined through pharmacy claims. Adherence was determined as receipt of the indicated pharmacologic(s) after a diagnosis of aneurysm or coronary artery disease. Adherence was compared between those with aneurysms and coronary disease using univariable logistic regression.ResultsAfter exclusions, 194,144 patients with an aortic aneurysm and 3,946,782 with coronary artery disease were identified. Overall adherence was low (45.0%) and differed significantly by aneurysm subtype: highest in isolated thoracic (45.9%) and lowest in isolated abdominal aneurysms (42.6%). Adherence levels declined significantly after 1 year by about 15% in each aneurysm subtype. All subtypes of aneurysm had a significantly lower odds of adherence compared to those with coronary disease with odds ranging from 0.61 in those with isolated abdominal aneurysms to 0.80 with isolated thoracic aneurysms.ConclusionsAdherence among those with aortic aneurysms is very low, differs by subtype, and declines with time. Levels of adherence in those with aortic aneurysms is significantly lower compared to those with coronary artery disease. This should prove a reasonable target for implementation initiatives.     

颈内动脉狭窄伴未破裂颅内动脉瘤患者的临床特点及危险因素

目的：探讨颈内动脉狭窄伴未破裂颅内动脉瘤患者的动脉瘤特点及危险因素。方法：选择颈内动脉狭窄患者120例，其中合并未破裂颅内动脉瘤患者10例为观察组，其余110例患者为对照组。分析观察组患者的动脉瘤特点及危险因素。结果：观察组共检测到动脉瘤11个，1例(10%)患者存在2个动脉瘤，其余均为单一动脉瘤；1例(10%)患者动脉瘤直径为7 mm, 9例(90%)患者动脉瘤直径为1～4mm;动脉瘤位于椎基底动脉尖1例(10%),位于颈内动脉系统9例(90%);动脉瘤与狭窄位于同一血管者有8例(80%);位于不同血管者有2例(20%);2组年龄、颈内动脉狭窄程度以及合并糖尿病、高血压、高脂血症、冠心病、饮酒史、吸烟史、缺血性卒中史等比较，差异无统计学意义(P均>0.05);经多因素Logistic回归分析显示，女性存在动脉瘤更多见[r=5.111,95%C1 (1.340～19.492),P=0.017]。结论：颈内动脉狭窄伴未破裂颅内动脉瘤多为单一动脉瘤、动脉瘤直径多<5 mm、多位于颈内动脉系统且动脉瘤与狭窄位于同一血管者较多见；女性存在动脉瘤更多见，临床应加以重视。     

Effects of coronary insufficiency on the early and late results in patients surgically treated for aneurysm of the sub-renal abdominal aorta

Between 1973 and 1988, 200 patients underwent repair of unruptured aortic aneurysm located distal to the renal arteries. There were 181 men (90%) and the mean age was 68.8 years. The most serious associated disease was arteriosclerotic heart disease which was present in 102 patients (51%): 48 patients had angina pectoris; 59 patients had previous myocardial infarct; 8 patients had ischemic myocardiopathy. Associated cerebrovascular disease was found in 29 patients (15%). Of these 200 patients, 36% had no symptoms relating to the aneurysm. The aneurysm was associated with iliac aneurysm (19%), iliac occlusion (14%), distant femoral occlusion (14%). In patients with history of coronary arteries disease (102), 39 (18%) had a coronary angiography prior the elective resection, 18 (9%) coronary artery bypass surgery underwent elective myocardial revascularisation prior to elective resection of their aneurysm. The treatment was by graft replacement and exclusively by graft inclusion. RESULTS: Death occurred within 30 days of treatment in 5 patients (2.5%). The first cause of early death was myocardial infarct (3). Early peripheral vascular complication occurred within 30 days in these 200 patients and were thromboembolism in 12 patients and colic ischemia in 8 patients. Of the 83 patients (1975-1983) who survived operation, follow up information regarding survival was obtained in 79 patients. The overall 5 and 8 years survival rates in percentage in the series were 69% and 50%. The survival rate was greatest in patients free of associated disease and worse in patients with myocardial infarctus. Subsequently 24 vascular operations were performed in these patients: 7 iliac aneurysms, 16 occlusive lesions and 2 false aneurysms. DISCUSSION: Young (15) and associates reported an operative mortality rate of 6.3% for elective aneurysm resection but found that 20% of the patients with pre-operative evidence of coronary artery disease had post-operative myocardial infarct of which 58% were fatal. Hertzer and colleagues (6), using routine coronary angiography prior to elective aortic reconstruction, have documented a 59% incidence of significant anatomic coronary artery disease. This incidence increased to 95% in patients with abdominal aortic aneurysm and suspected coronary artery disease. Only one patient of the 68 patients with an abdominal aortic aneurysm had normal coronary arteries in their series. Thus, considering the omnious implications of coronary artery disease in patients with abdominal aortic aneurysms, routine preoperative coronary angiography has been recommended. For Brown and coll. (1), it would appear that the risk of prophylactic coronary artery revascularisation may be greater than that for elective abdominal aortic aneurysm resection alone in the older age group. For the authors, only patients which instable angina pectoris or angina pectoris with a myocardial infarct had a coronary angiography. The coronary artery bypass is recommended for left maintrunk obstruction or diffuse multivessel coronary artery disease.