Decreased nitrate-mediated dilatation in patients with coronary artery ectasia: an ultrasonographic evaluation of brachial artery

BACKGROUND Evaluation of endothelial function in isolated coronary artery ectasia (ICAE) with flow-mediated dilation (FMD) is limited and use of flow mediated vasodilation as a surrogate marker for the extent of coronary atherosclerosis remains unknown. Thus, the following study was done to evaluate for endothelial dysfunction (ED) in subjects with ICAE by assessing the FMD in the brachial artery. METHODS This was an observational study, conducted at a referral hospital providing tertiary care in India between June 2017 and November 2018. Fifty patients with ICAE and fifty control patients with normal coronary arteries (NCA) on coronary angiogram, done by using a standard Seldinger technique via femoral route, were the subjects of the study. Brachial artery FMD was determined by using a highresolution ultrasound system (Samsung RS80A) using a linear transducer of a frequency of 7.5 Mega Hertz. RESULTS The groups had same baseline characteristics in terms of age, sex etc. (all P values > 0.05). However, values of serum uric acid and low-density lipoproteins were statistically significantly higher in ICAE subjects (P < 0.0001). Whereas, dilatation of brachial artery in response to shear stress was significantly lower in patients with ICAE subjects than in patients with normal coronaries. (8.85 ± 0.49 vs. 12.83 ± 0.45, P < 0.0001). Marki’s classification, type 1, type 2, type 3 and type 4 coronary artery ectasia (CAE) was present in 8 (16 %), 4 (8 %), 13 (26 %), and 25 (50 %), respectively. CONCLUSIONS Atherosclerosis may play a pivotal role in the genesis of ICAE. Hyperlipidaemia may have a specific role in the disease process. Further research is required to evaluate the exact molecular mechanisms involved in CAE. KEYWORDS Coronary Artery Disease, Ectasia, Endothelial Dysfunction, Hyperlipidaemia

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Role of QRS fragmentation in 12-lead surface ECG in prediction of isolated epicardial coronary artery ectasia and its anatomical distribution in patients without acute coronary syndromes

The Egyptian Heart Journal ◽

10.1186/s43044-020-00054-4 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Diaa Kamal ◽

Moataz Hashem

Keyword(s):

Coronary Artery ◽

Acute Coronary Syndromes ◽

Coronary Artery Ectasia ◽

Anatomical Distribution ◽

Epicardial Coronary Artery ◽

Surface Ecg ◽

Qrs Fragmentation ◽

Coronary Syndromes

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A pebble clogging a river: a case report of thrombosed coronary aneurysmal ectasia

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa274 ◽

2020 ◽

Author(s):

Akshar Jaglan ◽

Tarek Ajam ◽

Steven C Port ◽

Tanvir Bajwa ◽

A Jamil Tajik

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Kawasaki Disease ◽

Treatment Options ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Coronary Artery Ectasia ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome ◽

Patient Reported

Abstract Background Coronary artery ectasia (CAE) is a rare anomaly that can present at any age. Predisposing risk factors include Kawasaki disease in a younger population and atherosclerosis in the older generation. We present a unique case of the management of a young woman diagnosed with multivessel CAE with aneurysmal changes in the setting of acute coronary syndrome and subsequently during pregnancy. Case summary A 23-year-old woman presented with acute onset chest pain. Electrocardiogram revealed no ischaemic changes; however, troponin I peaked at 16 ng/mL (reference range 0–0.04 ng/mL). Echocardiogram showed apical dyskinesis with preserved left ventricular ejection fraction. Coronary angiography showed multivessel CAE along with significant thrombus burden in an ectatic lesion of the left anterior descending artery. Since the patient was haemodynamically stable, conservative management with dual antiplatelet therapy and anticoagulation was started. On follow-up, coronary computed tomographic angiogram illustrated resolution of the coronary thrombi and echocardiogram showed improvement to the apical dyskinesis. It was presumed that Kawasaki disease was the most likely aetiology of her disease. Subsequently the patient reported that, contrary to medical advice, she was pregnant, adding another layer of complexity to her case. Discussion Coronary artery ectasia can be discovered as an incidental finding or can present with an acute coronary syndrome. Management is challenging in the absence of randomized trials and large-scale data. Treatment options include medications, percutaneous intervention, and surgical revascularization. Close surveillance is required in these patients to assess progression of disease. Here we discuss treatment options during acute coronary syndrome and pregnancy.

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Predictive value of brachial artery flow-mediated dilation on coronary artery abnormality in acute stage of Kawasaki disease

Scientific Reports ◽

10.1038/s41598-021-87704-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yizhou Wen ◽

Xianmin Wang ◽

Yonghong Guo ◽

Mei Jin ◽

Jimei Xi ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Brachial Artery ◽

Characteristic Curve ◽

Coronary Aneurysm ◽

Acute Stage ◽

Flow Mediated Dilation ◽

Strong Negative Correlation ◽

Coronary Artery Abnormality ◽

Artery Flow

AbstractCoronary artery abnormalities (CAAs) are a severe complication of Kawasaki disease (KD) that may lead to cardiovascular events. Given the evidence that brachial artery flow-mediated dilation (FMD) decreases in children after the onset of KD, we hypothesized that it could be an early marker of CAA development in the acute stage and investigated its relationship with variation in the coronary artery diameter. A total of 326 sex- and age-matched children were enrolled, including 120 with KD, 109 febrile children and 97 healthy controls. In this study, FMD was significantly decreased in the KD group compared with the febrile and healthy groups. FMD was lower in the CAA group than in the no coronary artery abnormality group. The comparison of FMD showed an obvious difference among the CAA subgroups. The FMD in the coronary aneurysm (CA) group showed a strong negative correlation with the pretreatment maximum coronary artery Z-score (preZmax). While preZmax was 2.5, the receiver operating characteristic curve indicated an optimal cutoff point of 3.44% for FMD. FMD ≤ 3.44% could be considered as a signal of coronary lesions in acute stage of KD.

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Off-pump coronary artery bypass concomitant with retrieval of broken guide wire stuck in the brachial artery: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01867-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuan Xue ◽

Lu Dai ◽

Wenjian Jiang ◽

Hongjia Zhang

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Brachial Artery ◽

Guide Wire ◽

Artery Bypass ◽

Effective Means ◽

Coronary Intervention ◽

Off Pump ◽

Pump Coronary Artery Bypass ◽

The Right

Abstract Background The broken guide wire could get stuck anywhere during coronary artery angiography, but the broken guide wire in the brachial artery is extremely rare. Case presentation In this report, we describe our experience with a case of off-pump coronary artery bypass (OPCABG) concomitant with the retrieval of a broken guide wire stuck in the brachial artery: a 56-year-old male patient was referred to our hospital because of tri-vessel disease and a broken guide wire stuck in the right brachial artery. He received OPCABG concomitant with the retrieval of the broken guide wire stuck in the brachial artery under general anesthesia. The patient was discharged uneventfully, and 12 months follow-up showed an excellent surgical outcome. Conclusion Open surgery is an effective means for treating patients with a guide wire stuck in the brachial artery during percutaneous coronary intervention.

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