Discussion
Saccular coronary artery aneurysm
Pathophysiology
Coronary artery aneurysms (CAAs) describe focal dilatation of a coronary artery diameter greater than 1.5 times that of an adjacent reference segment. CAAs can be classified by shape, size, wall composition, and etiology. By shape, CAAs can be classified into fusiform in which the longitudinal diameter exceeds the transverse diameter, or saccular, in which the transverse diameter exceeds the longitudinal diameter.
Epidemiology
Saccular CAAs can affect any coronary artery but are most commonly found to affect the left anterior descending artery. They can be caused by many different pathologies, including atherosclerosis, which is the most common cause of CAAs, or other vasculopathies, such as Takayasu, polyarteritis nodosa, granulomatis with polyangiitis, etc.
Clinical presentation
Patients with CAAs can be asymptomatic or present with typical or atypical chest pain, especially when associated with flow-limiting stenoses.
Imaging features
- ECG-gated unenhanced CT of the heart: Focal dilatation of the midright coronary artery.
- ECG-gated CTA of the heart: Focal dilatation of the mid-RCA with the transverse diameter measuring greater than the longitudinal diameter in keeping with a saccular aneurysm. There is an associated layering thrombus in the aneurysm without critical stenosis.
Treatment
Management is tailored to each clinical scenario and associated risk factors. Management in asymptomatic patients includes assessment for coronary stenoses, occlusion, and general coronary artery disease risk stratification. Symptomatic patients may require angiography with percutaneous or surgical revascularization.
References
- Jeudy J, White CS, Kligerman SJ, et al. Spectrum of coronary artery aneurysms: From the Radiologic Pathology Archives.Radiographics. 2018;38(1):11-36.
- Kawsara A, Núñez Gil IJ, Alqahtani F, et al. Management of coronary artery aneurysms. JACC Cardiovasc Interv. 2018;11(13):1211-1223.
- Matta AG, Yaacoub N, Nader V, et al. Coronary artery aneurysm: A review. World J Cardiol. 2021;13(9):446-455.
