![]() In the right posterolateral branch, an aspiration catheter was advanced over a guidewire however, it would not advance through the occlusion. Right coronary artery following thrombectomy Additionally, if preventative treatment is advised there is no recommendation on whether it should be for a short duration or indefinitely. As a result, there has not been a consensus on preventative treatment to include an antiplatelet and/or an anticoagulant, versus dual antiplatelet therapy (DAPT), versus triple therapy (DAPT plus anticoagulation). īecause CAE is so rare, it has been challenging for the research community to conduct large trials on how to appropriately manage these patients. However, a thrombus in the dilated artery may embolize distally to a smaller segment of the vessel, resulting in a presentation with acute myocardial infarction (AMI). An overwhelming majority of CAE is incidentally detected during coronary angiography or computed tomography (CT). Some have suggested possible etiologies to include: Kawasaki disease, atherosclerosis, mycotic or septic emboli, Marfan syndrome, Takayasu disease, systemic lupus erythematosus, polyarteritis nodosa, or Loeys-Dietz syndrome. The pathophysiology of CAE is poorly understood however, it could be considered as excessive remodeling by proteolytic enzyme degradation of the extracellular matrix and overexpression of matrix metalloproteinases resulting in luminal expansion. There are four classifications of CAE: Type 1 - diffuse ectasia in two or more vessels Type 2 - diffuse ectasia in one vessel, and localized ectasia in another Type 3 - diffuse ectasia limited to one vessel Type 4 - localized ectasia limited to one vessel. Several studies have suggested that the most commonly involved coronary artery is the right coronary artery (RCA). CAE differs from coronary aneurysms, which are identified by a focal dilation. CAE dilation is defined as a diameter 1.5 times larger than an adjacent normal coronary artery and must include at least one-third of the affected artery's length. Additionally, it is suggested that only 23.7% have isolated CAE, while the remaining also has significant coronary artery disease (CAD). In one study of 20,000 left heart catheterizations, CAE had a prevalence of only 0.85%, with a male predominance of more than 90%. There are currently no recommendations on the use of antiplatelet or anticoagulation therapy in patients with CAE.Ĭoronary artery ectasia (CAE) is a rare dilation of the lumen in coronary arteries, either localized to one vessel or diffuse in multiple vessels. We present this case to discuss the prevention of complications from CAE. Angioplasty successfully restored TIMI-3 flow throughout the RCA. Additionally, he was found to have severely diffuse CAE in all of his coronary arteries. He was taken directly to the catheterization laboratory for coronary angiography, which identified a mid-RCA thrombus with thrombolysis in myocardial infarction (TIMI)-1 flow, and distal to that in the right posterolateral branch was another thrombus with TIMI-0 flow. A 12 lead electrocardiogram (EKG) showed an ST elevation in the inferior leads with reciprocal changes, suggestive of myocardial infarction in the right coronary artery (RCA). Coronary artery ectasia (CAE) is a rare dilation of the lumen in coronary arteries, either localized to one vessel or diffuse in multiple vessels. A 31-year-old white male with no significant past medical or cardiac history, presented with severe sudden onset chest pain, diaphoresis, shortness of breath, and nausea without vomiting.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |