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首页> 外文期刊>Cardiovascular therapeutics >Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease
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Coronary Artery Ectasia in Atherosclerotic Coronary Artery Disease, Inflammatory Disorders, and Sickle Cell Disease

机译：动脉粥样硬化性冠状动脉疾病，炎性疾病和镰状细胞病中的冠状动脉扩张症

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Coronary artery ectasia (CAE) or aneurysm is usually defined as dilation 1.5-fold the normal vessel diameter. It has an incidence of 1.4-5.3% and is associated with a wide variety of etiologiesmainly congenital, atherosclerotic, and inflammatory ones. CAE is very common in sickle cell disease, and possibly sickle cell trait, with an incidence of 17.7%. It is likely related to the inflammatory process associated with hemoglobin S. Prognosis depends mainly on the underlying etiology. Atherosclerotic CAE does not carry additional risks compared to atherosclerotic coronary artery disease (ACAD) without ectasia. However, isolated CAE in the absence of ACAD carries an increased risk of myocardial infarction (MI) due to vasospasm, slower coronary blood flow, and thrombosis, typically within the dilated segments. Due to lack of studies and guidelines, management recommendations are based on personal experiences. Therapy should be tailored to each individual case after assessment of severity, history of complications, underlying etiology, and comorbidities. Treatment of underlying condition and avoidance of exacerbating factors are essential. Medical therapy in general may include antiplatelets, -blockers, angiotensin-converting enzyme inhibitors statins, and dihydropyridine calcium channel blockers. In severe CAE or history of MI, the addition of anticoagulation therapy after assessing bleeding risk may be warranted. In acute MI, the large thrombus burden in the dilated segment makes the percutaneous approach very challenging. Aspiration attempts can result in distal thromboembolization. Survival is better in bypass grafting than with medical therapy. Nonetheless, bypass grafting does not improve survival in atherosclerotic CAE. Depending on the physical characteristics of aneurysm, different surgical approaches can be sought; however, the ideal one is unclear.
机译：冠状动脉扩张（CAE）或动脉瘤通常定义为扩张至正常血管直径的1.5倍。它的发生率为1.4-5.3％，并与多种病因有关，主要是先天性，动脉粥样硬化和炎性。 CAE在镰状细胞疾病中很常见，并且可能是镰状细胞性状，发生率为17.7％。它可能与血红蛋白S相关的炎症过程有关。预后主要取决于潜在的病因。与没有扩张的动脉粥样硬化性冠状动脉疾病（ACAD）相比，动脉粥样硬化CAE没有其他风险。但是，由于血管痉挛，较慢的冠状动脉血流和血栓形成（通常在扩张段内），没有ACAD的孤立CAE会增加心肌梗塞（MI）的风险。由于缺乏研究和指导，因此管理建议基于个人经验。在评估严重程度，并发症史，潜在病因和合并症之后，应针对每个病例​​量身定制治疗方案。基本情况的治疗和避免加重因素至关重要。药物治疗通常可包括抗血小板药，β受体阻滞剂，血管紧张素转化酶抑制剂他汀类药物和二氢吡啶钙通道阻滞剂。在严重的CAE或MI病史中，可能需要在评估出血风险后再进行抗凝治疗。在急性心肌梗死中，扩张段的血栓负担很大，因此经皮入路非常具有挑战性。抽吸尝试可能导致远端血栓栓塞。旁路移植的存活率优于药物治疗。尽管如此，旁路移植不能改善动脉粥样硬化CAE的存活率。根据动脉瘤的物理特征，可以寻求不同的手术方法。然而，理想的还不清楚。

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