Pathophysiology, Diagnosis, and Management of Coronary Artery Aneurysms: A Review

Abstract

Coronary artery aneurysms (CAAs) are frequent entities that are encountered in up to 8% of patients undergoing coronary imaging. The most frequent cause of CAAs is atherosclerotic “positive remodeling” of coronary arteries, while congenital, inflammatory, and traumatic etiologies could also be seen. Aneurysms serve as foci for thrombus formation, which may occlude the aneurysmatic segment or embolize distally. Rupture of an aneurysm is a rare yet potentially catastrophic complication of a CAA. Most aneurysms can be managed medically, while percutaneous exclusion of an aneurysm from coronary circulation is appropriate for CAAs that are prone to rupture or thrombosis. Surgical correction remains the ultimate option for patients who are not amenable to percutaneous management or those with a compelling indication for surgery. This review summarizes the available knowledge on the nomenclature, classification, pathophysiology, diagnosis, and management of CAAs, with a particular emphasis on treatment strategies to mitigate the risks associated with CAAs.