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February 1990:279-82
PAUL A. TUNICK, MD, FACC, JAMES SLATER, MD, FACC, ITZHAK KRONZON, MD, FACC,
EPHRAIM GLASSMAN, MD, FACC
New York, New York
The incidence, angiographic features and natural history of up (range 1 to 90 months [mean 30]) was obtained in aU 20
discrete atherosclerotic coronary aneurysms were evalu- patients. There were two cardiac and two noncardiac
ated in 20 patients with 22 aneurysms (0.2% of 8,422 deaths; 12 patients had coronary bypass surgery and of 16
patients referred for coronary angiography). Fifteen aneu- survivors, 13 were angina-free.
rysms (68%) were in the left anterior descending, four In conclusion, discrete coronary aneurysms are much
(18%) in the circumflex, two (9%) in the right and one (5%) less common than diffuse ectasia. Unlike ectasia, they are
in the left main coronary artery. Aneurysm diameter never found in arteries without severe stenosis, and are
ranged from 4 to 35 mm (mean 8); 95% of aneurysms were most common in the left anterior descending coronary
adjacent to a severe obstruction. artery. Associated coronary artery disease is more severe in
Seventy-five percent of patients had severe triple vessel patients with discrete aneurysms than in those with diffuse
disease that included severe left main disease in 15%. Total ectasia. Discrete coronary aneurysms do not appear to
obstruction of one or two arteries was present in 75%. In rupture, and their resection is not warranted.
patients with wall motion abnormalities, 78% of the abnor- (J Am CoIl CardioI1990;15:279-82)
malities were in the distribution of the aneurysm. Follow-
Results Discussion
Clinical features. The clinical characteristics and coro- Discrete aneurysms versus ectasia. Coronary aneurysms
nary anatomy of the patients are summarized in Table 1. have been recognized since 1812 (7). Probably the most
There were 20 patients with a localized coronary aneurysm; common cause is Kawasaki disease (8). Other reported
15 patients were male and 5 female. Their average age was 69 causes include congenital anomalies, infections, syphilis and
years (range 54 to 84). These 20 patients represented 0.2% of systemic lupus erythematosus (8,9). Coronary ectasia due to
the 8,422 patients with angiographically apparent coronary atherosclerotic disease has been reported in 2% (2) and 4.9%
artery disease during the study period. (5) of patients; the latter incidence rate was observed in
Coronary aneurysms (Table 1). There were 22 aneurysms 20,087 patients enrolled in the Coronary Artery Surgery
in the 20 patients (2 patients had 2 aneurysms each). Fifteen Study (CASS) Registry. The 978 CASS patients with aneu-
lACC Vol. 15, No.2 TUNICK ET AL. 281
February 1990:279-82 DISCRETE CORONARY ANEURYSMS
rysmal disease included those with fusiform disease or coronary artery. In addition, although among CASS Registry
diffuse ectasia. An illustrated saccular aneurysm in that patients triple vessel disease was more common in those
report (5) occurs in an artery that also demonstrates diffuse with than in those without aneurysmal disease (42% versus
ectasia, whereas all of our discrete aneurysms occurred in 34%), the severity of associated coronary disease was
arteries that were otherwise of normal or smaller than greater in our patients with discrete aneurysms. Seventy-five
normal caliber and that did not demonstrate diffuse widen- percent of our patients had severe triple vessel disease;
ing. Ninety of the CASS patients had aneurysmal disease in furthermore, 15% had severe left main stenosis and 75% had
an artery without severe stenosis (no stenosis in 21 and total coronary occlusion.
<70% stenosis in 69). In contrast, in all of our patients the Follow-up. Despite the severe occlusive disease present
aneurysm occurred in an artery with severe or total obstruc- in our patients, the follow-up data do not indicate a grave
tion. prognosis. This finding probably reflects at least in part the
There are two further distinctions between patients with efficacy of both medical and surgical therapy. In fact, no
discrete aneurysms and those with ectasia. Aneurysmal patient died directly as a complication of the aneurysm
disease in the CASS Registry patients (5) was found most during the follow-up period, and there was no incidence of
frequently in the right coronary artery, whereas 68% of the cardiac tamponade or even unexplained sudden death that
aneurysms in our study were in the left anterior descending could have been due to rupture of the aneurysm. Further-
artery, and only two aneurysms (9%) were in the right more, no thrombus was visualized in the aneurysms during
282 TUNICK ET AL. JACC Vol. 15, No.2
DISCRETE CORONARY ANEURYSMS February 1990:279-82