Coronary artery aneurysms in acute coronary syndrome: case series, review, and proposed management strategy.
J Invasive Cardiol
; 26(6): 283-90, 2014 Jun.
Article
en En
| MEDLINE
| ID: mdl-24907086
ABSTRACT
Coronary artery aneurysm (CAA) is an uncommon clinical finding, with an incidence varying from 1.5%-4.9% in adults, and is usually considered a variant of coronary artery disease (CAD). CAA identified in the context of acute coronary syndrome (ACS) represents a unique management challenge, particularly if the morphology of the CAA is suspected to have provoked the acute clinical syndrome. CAA is associated with thrombus formation due to abnormal laminar flow, as well as abnormal platelet and endothelial-derived pathophysiologic factors within the CAA. Once formed, mural thrombus may potentiate the deposition of additional thrombus within aneurysmal segments. Percutaneous revascularization of CAA has been associated with complications including distal embolization of thrombus, no-reflow phenomenon, stent malapposition, dissection, and rupture. Presently, there are no formal guidelines to direct the management of CAA in patients presenting with ACS; controversies exist whether conservative, surgical, or catheter-based management should be pursued. In this manuscript, we present an extensive review of the existing literature and associated clinical guidelines, and propose a management algorithm for patients with this complex clinical scenario. Armed with this perspective, therapeutic decisions may be tailored to synthesize patient factors and preferences, individualized clinical assessment, and existing American Heart Association/American College of Cardiology guidelines for management of ACS.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Algoritmos
/
Aneurisma Coronario
/
Manejo de la Enfermedad
/
Síndrome Coronario Agudo
Tipo de estudio:
Guideline
/
Prognostic_studies
Límite:
Adult
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Invasive Cardiol
Asunto de la revista:
CARDIOLOGIA
Año:
2014
Tipo del documento:
Article
País de afiliación:
Estados Unidos