CONGRESS ABSTRACT

Introduction: Coronary artery ectasia (CAE) is the dilation of the coronary artery 1.5 times above its normal caliber. Even if its pathophysiology is not completely understood, in adult patients atherosclerosis is considered the main etiology by inducing an exaggerated positive remodeling; conversely, CAE can be caused by vessel injury after coronary intervention. Most cases are detected incidentally, but CAE can also be the culprit for acute coronary syndromes. Case report: A 62-years-old male patient with multiple cardiovascular risk factors and with history of posterior-inferior ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention on right coronary artery (RCA), was admitted to our emergency department for acute chest pain, unresponsive to sublingual nitrate administration. The electrocardiogram (EKG) showed ST-segment depression in the anterior leads and ST-segment elevation in posterior leads, so catheterization laboratory was activated: coronary angiography (CAG) showed acute occlusion of the mid circumflex artery, so thrombus aspiration and angioplasty were performed (figure 1A). All coronary arteries appeared ectasic and, interestingly, proximal RCA blood flow seemed to be outside from the previously implanted stent (figure 1B). To better understand this finding, cardiac computed tomography angiography (CCTA) was executed and revealed a fusiform aneurysm (18×28 mm) with proximal stent occlusion and peripheral blood flow (figure 2). The Heart Team indicated dual antithrombotic therapy (DAT) with acetylsalicylic acid and warfarin and follow-up with CCTA after 6 months to assess aneurysm evolution. Discussion: CAE determines abnormal blood flow, increased blood viscosity and coagulation activation,so it increases the risk of acute coronary events. Its treatment should be individualized based on the disease phenotype, the patient's characteristics and the clinical presentation, in order to choose between percutaneous and surgical revascularizations or medical therapy alone. CCTA can be useful to better characterize coronary aneurysm morphology, dimensions and blood flow. Conclusion: CAE management is controversial due to lack of evidence and absence of guidelines, even if its pathophysiology suggests a potential role for anticoagulant drugs. CCTA plays a key role to better characterize ambiguous CAG findings.