Aneurismas coronarios no asociados a estenosis en las arterias coronarias: Tratamiento conservador y evolución en un registro de 6 casos / Coronary aneurysms not associated to stenosis of coronary arteries: conservative treatment and evolution in six patients
Arch. cardiol. Méx
; Arch. cardiol. Méx;75(3): 310-315, jul.-sep. 2005. ilus
Article
em Es
| LILACS
| ID: lil-631905
Biblioteca responsável:
MX1.1
RESUMEN
Los aneurismas coronarios son una patología relativamente infrecuente, con una incidencia anual del 1-2%. La causa más frecuente es la ateroesclerosis coronaria y en este caso se suelen asociar a estenosis en las arterias coronarias. Revisamos todos los estudios angiográficos realizados en los últimos 7 años y recogimos los casos de 6 pacientes ingresados por síndrome coronario agudo a los que se realizó coronariografía, demostrando dilataciones aneurismáticas en las arterias coronarias sin relación con estenosis proximales o distales. A pesar de la ausencia de estenosis coronarias, pensamos que la enfermedad ateroesclerótica podría ser la causa mediante lesión del endotelio y la elástica interna con el depósito de lípidos, células musculares lisas, colágeno, macrófagos y linfocitos T, con afectación final de las capas media y adventicia, y neoformación de vasa-vasorum. Se desconoce la evolución de los aneurismas coronarios sin estenosis significativas asociadas y sin otra causa etiológica tratable. A tenor de la escasa literatura publicada al respecto y con nuestra experiencia creemos que el tratamiento médico conservador podría ser una buena opción en estos casos. En el seguimiento a medio-largo plazo no se registraron eventos cardíacos mayores en ningún paciente.
ABSTRACT
Coronary artery aneurysms are a relatively infrequent finding with an incidence of 1-2% per year. The most frequent cause is atherosclerosis and, in that case, they are always associated to stenosis of coronary arteries. We reviewed the coronary angiographic studies performed in the past seven years and we identified six patients that were admitted with an acute coronary syndrome, whose angiographic studies showed the presence of aneurysms in, at least, one of the coronary arteries. In these patients, we found no relation between aneurysms and distal or proximal stenosis. Although there was no angiographic evidence of classical coronary atherosclerosis, we think that atherosclerotic disease could have been the etiological cause, due to injury of the endothelium and media by deposits of lipids, smooth muscle cells, collagen, macrophages, and T-lymphocytes that would have damaged the adventitia layers of the vessel wall, stimulating "vasa-vasorum" neovascularization. The evolution of coronary aneurysms without associated stenosis in the same coronary artery and without another potentially treatable cause is unknown. Due to the limited literature regarding this issue and, taking into account our experience, we feel that, in these cases, medical treatment might be a good option as we detected no major cardiac events in any patient at mid and long-term follow up.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
LILACS
Assunto principal:
Aneurisma Coronário
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Humans
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Male
Idioma:
Es
Revista:
Arch Cardiol Mex
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Arch. cardiol. Méx
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Archivos de cardiologia de México
Assunto da revista:
CARDIOLOGIA
Ano de publicação:
2005
Tipo de documento:
Article
País de afiliação:
Espanha