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A 61 year old woman without any significant past medical history was admitted to our hospital with acute coronary syndrome. Coronary angiography revealed diffuse coronary ectasia without true evidence of stenosis. The right anterior oblique view showed two coronary aneurysms in the circumflex coronary artery and an ectatic left anterior descending coronary artery (upper panel). In order to evaluate the morphology of this vessel abnormality and to definitely exclude coronary artery stenosis, intravascular ultrasound (IVUS) was performed. IVUS visualised the complete absence of any atherosclerotic changes in the normal part of the circumflex artery (panel A) and in the aneurysmic vessel segments (panels B and C).
Coronary artery aneurysm is a rare clinical entity for which a variety of aetiologies have been reported. Coronary artery aneurysm can be atherosclerotic in origin, secondary to coronary interventions, or inflammatory in origin, including autoimmune vasculitis (Takayasu disease, systemic lupus erythematosus, polyarthritis nodosa), connective tissue disorders (Marfan’s syndrome, Ehlers-Danlos syndrome) and congenital lesions.
In contrast to the presented case, coronary artery aneurysm is most commonly found in primarily atherosclerotic coronary artery disease. Despite intense diagnostic approaches the exact aetiology of the coronary abnormality in this case could not be clarified. The disease has therefore been described as non-atherosclerotic and non-inflammatory coronary ectasia, with vasculitis-like vessel alterations of unknown origin.