What is Coronary Ectasia?
Coronary artery ectasia, or CAE, is a condition where the coronary artery, the blood vessel that supplies the heart, stretches or enlarges. “Ectasia” specifically means that the widening is spread out along the artery, as opposed to a “coronary aneurysm” which is a focused enlargement at a specific spot.
For a diagnosis of coronary artery ectasia, the enlarged segment has to be more than one-third the length of the artery, and its diameter must be more than 1.5 times that of a normal part nearby. While it can be identified through an examination technique called diagnostic coronary angiography, it’s not commonly found.
Coronary artery ectasia is classified into four types:
- Type 1: Widespread enlargement of two or three blood vessels.
- Type 2: Widespread enlargement in one blood vessel and localized disease in another.
- Type 3: Widespread enlargement in just one blood vessel.
- Type 4: Localized or segmental involvement, meaning only a specific part of a blood vessel is affected.
What Causes Coronary Ectasia?
The reasons for the occurrence of coronary artery ectasia – which is a condition where the coronary arteries swell – can sometimes be hard to pin down. Atherosclerosis, a condition where the arteries harden due to fat and cholesterol build-up, is the top cause behind more than half of these cases in adults. On the other hand, Kawasaki disease, an illness causing inflammation in blood vessels, usually is the main cause in children and young adults.
The occurrence of coronary artery ectasia due to genetic reasons is rare. A few conditions that can lead to it include atherosclerosis, Kawasaki disease, blood clots from dangerous bacteria, Marfan syndrome (a genetic disorder affecting connective tissue), and various types of inflammation of arteries, such as polyarteritis nodosa, Takayasu disease, or systemic lupus erythematosus. It can also be caused by certain medical procedures, including percutaneous transluminal coronary angioplasty (PTCA, a procedure to open blocked coronary arteries), stents (small expandable tubes to treat blocked arteries), and directional coronary atherectomy (a method to remove blockages from the coronary arteries).
There are several factors that can increase the risk of getting coronary ectasia. These include high blood pressure, smoking, and the use of illegal drugs such as cocaine.
Risk Factors and Frequency for Coronary Ectasia
Coronary artery ectasia, a condition where the coronary artery swells and dilates, affects between 0.3% and 4.9% of people. In fact, around 4.9% of coronary angiograms, a test to see the blood flow in your heart, reveal this condition.
- The size of the swollen artery defines the condition’s severity: small (under 5 mm), medium (5 to 8 mm), or giant (over 8 mm).
- It is most likely to occur in the right coronary artery (68% of cases), the proximal left anterior descending artery (60% of cases), or the left circumflex artery (50% of cases).
- Based on the shape, the condition can be of two types: saccular (if the artery’s width is larger than its length), and fusiform (if the artery’s length is longer than its width).
Signs and Symptoms of Coronary Ectasia
Coronary artery ectasia, or CAE, usually doesn’t have symptoms. However, when symptoms do appear, they can be connected to other health conditions like heart disease, Kawasaki disease, or disorders that affect the body’s connective tissue. People with CAE may experience chest pain during or after physical exertion, and they are also at risk of sudden, severe heart problems called acute coronary syndromes.
The chest pain can happen because the blood flow in the arteries is slower or comes to a standstill. On its own, this can be enough to cause chest pain during exercise, even if there is no other artery disease present. Additionally, blood clots can form in the artery and either stick in place or break off and block the artery further down, triggering an acute coronary syndrome. The sluggish blood flow in the widened part of the artery makes both these situations more likely. Medical experts suspect that the widened (or ‘ectatic’) parts of the artery are more prone to suddenly narrowing, or ‘spasming’, which can also cause chest pain or acute coronary syndrome.
In people under 50 years old, if CAE is identified, it’s an important reminder for doctors to check for disorders of the body’s connective tissues and vasculitides, which are a group of diseases that cause inflammation of the blood vessels.
Testing for Coronary Ectasia
Coronary angiography is widely considered the best method for identifying an abnormal enlargement of the coronary artery, a condition known as coronary artery ectasia. Another important tool is intravascular ultrasound (IVUS). This allows doctors to examine the inside of the blood vessel and detect any abnormalities.
It’s common for people with coronary artery ectasia to have distortions in how blood flows around their body and how quickly it clears out of certain areas. This is linked to how severe the enlargement of the coronary artery is. Certain signs, like a delayed filling of blood vessels with dye, backward flow of blood, and blood pooling in the enlarged part of the coronary artery can suggest this type of difficulty.
There are also other investigative techniques such as Magnetic Resonance Angiography (MRA) and Coronary Computed Tomography Angiography (CTA). For patients who are being monitored over time, MRA is usually the preferred method.
Treatment Options for Coronary Ectasia
Managing coronary artery ectasia (CAE), a rare heart condition, can be challenging due to the lack of large-scale clinical trials comparing treatment methods. When there’s also coronary artery disease (CAD), it’s crucial to rigorously manage risk factors related to heart disease.
If a patient with CAE experiences chest pain or reduced blood flow to the heart muscle, common treatments include aspirin, cholesterol-lowering medications (statins), and medications that relieve heart muscle strain.
In situations where CAE causes acute coronary syndromes – sudden, serious heart conditions such as heart attacks – additional therapeutic measures might be required. These could include thrombolysis (breaking up blood clots), heparin (a blood-thinning medication), and special medications called glycoprotein IIb/IIIa receptor inhibitors that prevent blood clotting. At times, a procedure known as thrombus aspiration may be needed to remove the clot during an invasive procedure called primary percutaneous coronary intervention (PCI).
In specific cases where chest pain continues despite maximum medication therapy, procedures to open up blocked arteries can be beneficial. These could either be minimally invasive procedures (percutaneous interventions) or surgical interventions. When placing a stent (a small mesh tube) to keep the artery open, it’s essential to get the size right to avoid improper placement and the stent moving to other parts of the body (embolization).
Some medical experts suggest long-term use of blood thinners (anticoagulation); however, there is no clinical trial-proven benefit of this strategy for CAE. The expected benefits of this approach should outweigh the risk of bleeding.
In rare instances, surgery may be necessary for patients experiencing repeated complications. This surgery involves tying off both ends of the dilated vessel and replacing it with a bypass graft. Trying to repair the diseased vessel generally has poor results. It’s crucial to understand that due to the individual variations of CAE, each patient’s treatment must be personalized, based on their unique situation and medical history.
What else can Coronary Ectasia be?
When doctors are trying to figure out whether a patient has coronary ectasia, they also consider other potential diseases that have similar symptoms. These other diseases include:
- Atherosclerosis: a condition where plaque builds up inside the arteries
- Bacterial syphilis: a sexually transmitted disease
- Behcet disease: a rare disorder causing inflammation in blood vessels
- Ehler-Danlos syndrome: a group of disorders affecting connective tissues
- Fibromuscular dysplasia: a condition that causes abnormal growth in the walls of arteries
- Giant cell arteritis: an inflammatory disease of the blood vessels
- Kawasaki disease: a disease that causes inflammation in the walls of arteries throughout the body
- Marfan syndrome: a genetic disorder that affects the body’s connective tissue
- Mycotic aneurysm: an infection within the wall of an artery
- Septic emboli: a blood clot caused by a severe bacterial infection
Being aware of these diseases helps the doctors to diagnose the condition accurately.
What to expect with Coronary Ectasia
The outlook for a condition known as coronary artery ectasia largely depends on the severity of any existing heart disease. When coronary artery ectasia occurs together with heart disease, it can significantly increase the risk of severe heart problems. Even when coronary artery ectasia occurs on its own, it still places the individual at risk of heart muscle damage and heart attacks.
There are different types of coronary artery ectasia, with types 1 and 2 deemed more dangerous than types 3 and 4. So far, no studies have linked the size of the artery to the eventual health outcome.
Possible Complications When Diagnosed with Coronary Ectasia
Coronary ectasia, which is a heart condition, can lead to several complications. These include:
- Thrombus: This can cause a heart attack.
- Acute heart-related problems.
- The formation of a fistula (an abnormal connection) in the heart chambers.
- Thrombosis, which is the formation of blood clots inside the blood vessels.
- Distal embolization, a condition where a blood clot moves from where it was formed and causes a blockage in another place.
- Complications after placing a stent (a small tube that’s used to treat narrowed or weakened arteries in the body), such as:
- Misplacement of the stent.
- Embolization of stents, where the stent moves away from where it was placed and causes a blockage in another place.
- Thrombosis of the stent or formation of a clot in the stent.
- Restenosis, which is when an artery that was previously opened by a stent narrows again.
Preventing Coronary Ectasia
It’s important for patients to know that there’s no targeted treatment for coronary ectasia, a condition affecting the heart’s arteries. The most effective approach involves consistently following medication schedules intended to manage coronary artery health. In rare cases, surgery may be needed. If that happens, patients should be well-informed about the surgery process and what they’d need to do to recover properly after the operation.
