Coronary arterial ectasia

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).

Terminology

It is often defined as 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.

Epidemiology

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

Pathology

Etiology

It is attributed to atherosclerosis in 50% of patients while in ~25% of patients it may be congenital in origin.

Associations

• coronary artery disease: co-exists in the great majority of patients
• inflammatory or connective tissue diseases: 10-20% cases and include
  • connective tissue disorders
    • scleroderma
    • Ehlers-Danlos syndrome
    • form of ANCA-related vasculitides
    • syphilitic aortitis
    • Kawasaki disease
• purely congenital in origin in a small proportion of cases

Classification

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