Coronary arterial ectasia

Last revised by Joachim Feger on 6 Jan 2025

Coronary arterial ectasia (CAE) refers to diffuse dilatation of the coronary arteries. Under some classification systems, there is some overlap with the term coronary arterial aneurysms (which is a more focal dilatation) 1.

It is often defined as the dilatation of an arterial segment to a diameter at least 1.5 times (i.e. 150%) that of the adjacent normal coronary artery (unaffected segment) and involves at least 50% or more of the length of the artery 1.

They may be present in up to ~5% (range 3-8%) of angiographic and in ~1% (range 0.2-1.4%) of autopsy series.

It is attributed to atherosclerosis in 50% of patients while in ~25% of patients it may be congenital in origin such as in the setting of a coronary artery-to-pulmonary artery fistula.

One method of classification is 1:

  • type I: diffuse ectasia of two or three vessels

  • type II: diffuse ectasia of one vessel and localized disease in other, i.e. an aneurysm

  • type III: diffuse ectasia in only one vessel

  • type IV: focal coronary aneurysm in one vessel

Aneurysmal dilation of coronary arteries was first described by the French surgeon Charles Bougon in 1812 7-9. After several case reports of coronary aneurysms, a more widespread dilatation of the coronary arteries was described and discussed by the American physicians Maurice Packard and HF Wechsler in 1929 10, and later by the American cardiologist Salvador Trinidad and his colleagues in 1953 11.

The terms coronary aneurysm and coronary ectasia were used then interchangeably for many years until more recently 1 when the distinction was made between coronary aneurysm as a more focal dilation and coronary ectasia for more diffuse dilation of the coronary arteries 1,9,12.

Cases and figures

  • Case 1
  • Case 2: ARCAPA
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