Coronary artery aneurysm

Dr Rohit Sharma and Dr Henry Knipe et al.

Coronary artery aneurysms (CAA's) are an uncommon, predominantly incidental finding.

CAA is most common in men 3, likely reflecting the increased rates of atherosclerosis in men compared to women. Prevalence varies in the literature between 0.1-5% 4.

Most coronary artery aneurysms are asymptomatic. They can be associated with cardiac murmurs or present with chest pain or congestive cardiac failure.

Coronary artery aneurysms are defined as a focal dilatation of the coronary artery by at least 50% compared to a nearby artery or adjacent arterial segment and involve <50% of the artery length 2,4. They can be further classified by 4:

Coronary artery ectasia when there is dilatation but it involves >50% of the artery length 4. The subtype, giant coronary artery aneurysms, measure > 2 cm in diameter.

They may be associated with coronary arteriovenous fistulas to either cardiac veins (see case 3) or cardiac chambers.

  • atherosclerosis (50%)
  • congenital (17%)
  • mycotic, e.g. syphilis (10%)
  • vasculitis, e.g. Kawasaki disease (more common in Japan)
  • connective tissue disorders, e.g. systemic lupus erythematosus
  • trauma
  • iatrogenic, e.g. stent placement

There is no established treatment for CAA with medial and surgical options available 4. The five-year survival of CAA is ~70% 3,4.

Congenital coronary artery anomalies
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Article information

rID: 37916
Systems: Vascular, Cardiac
Section: Pathology
Synonyms or Alternate Spellings:
  • Giant coronary artery aneurysms
  • Coronary artery aneurysm
  • Giant coronary artery aneurysm
  • Coronary arterial aneurysm
  • Coronary artery aneurysms
  • Coronary arterial aneurysms

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Cases and figures

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    Case 1: giant CCA on CTCA
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    Case 1: giant CCA on angiography
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    Case 2
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    Case 3: with fistula to GCV
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    Case 4: Kawasaki disease
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