Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2021; 13(9): 446-455
Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.446
Coronary artery aneurysm: A review
Anthony Georges Matta, Nabil Yaacoub, Vanessa Nader, Nicolas Moussallem, Didier Carrie, Jerome Roncalli
Anthony Georges Matta, Vanessa Nader, Department of Cardiology, Toulouse University Hospital, Rangueil, Toulouse 31400, France
Anthony Georges Matta, Nabil Yaacoub, Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
Vanessa Nader, Faculty of Pharmacy, Lebanese University, Hadath 961, Lebanon
Nicolas Moussallem, Division of Cardiology, Faculty of Medicine, Holy Spirit University of Kaslik, Jounieh 961, Lebanon
Didier Carrie, Department of Cardiology, University Hospital Rangueil, Toulouse 31059, France
Jerome Roncalli, Department of Cardiology, University Hospital of Toulouse/Institute Cardiomet, Toulouse 31400, France
Author contributions: All authors have contributed equally to the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Jerome Roncalli, MD, PhD, Full Professor, Department of Cardiology, University Hospital of Toulouse/Institute Cardiomet, 1 Avenue du Professeur Jean Poulhès, Toulouse 31400, France.
Received: March 4, 2021
Peer-review started: March 4, 2021
First decision: June 7, 2021
Revised: June 9, 2021
Accepted: July 29, 2021
Article in press: July 29, 2021
Published online: September 26, 2021

Coronary artery aneurysm (CAA) is a clinical entity defined by a focal enlargement of the coronary artery exceeding the 1.5-fold diameter of the adjacent normal segment. Atherosclerosis is the main cause in adults and Kawasaki disease in children. CAA is a silent progressive disorder incidentally detected by coronary angiography, but it may end with fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation and distal embolization. The pathophysiological mechanisms are not well understood. Atherosclerosis, proteolytic imbalance and inflammatory reaction are involved in aneurysmal formation. Data from previously published studies are scarce and controversial, thereby the management of CAA is individualized depending on clinical presentation, CAA characteristics, patient profile and physician experience. Multiple therapeutic approaches including medical treatment, covered stent angioplasty, coil insertion and surgery were described. Herein, we provide an up-to-date systematic review on the pathophysiology, complications and management of CAA.

Keywords: Coronary artery aneurysm, Complications, Atherosclerosis, Coronary artery ectasia

Core Tip: Most patients with coronary artery aneurysm remain asymptomatic until the development of complications or the occurrence of obstructive coronary disease-related clinical manifestations. The underlying pathophysiology is miscellaneous. The ideal management of coronary artery aneurysm has not yet been defined, but computed tomography angiography is the recommended non-invasive test for long-term follow-up. Future prospective comparative trials targeted to define the appropriate strategy and the optimal time to intervene are required.