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Barioli et al. Vessel Plus 2024;8:13 https://dx.doi.org/10.20517/2574-1209.2023.68 Page 11 of 14

(389 CAA vs. 3,843 and re-MI. Secondary: MACE (OR: 4.04, 95%CI: 0.34- mechanical
non-CAA pts) TVR, need for 47.57; P = 0.17), re-MI (OR: 2.13, supportive devices
mechanical support 95%CI: 0.83-5.47; P = 0.08) were similar
were all non-significantly between groups
associated with CAE status
Núñez-Gil 256 ACS + CAA pts Retrospective 52 MACEs (Mortality, CAAs were independent risk
et al., vs. 500 ACS pts with PSM months Bleeding or MI) factors for both all-cause
[4]
2018 mortality (HR: 3.1, 95%CI: 1.8-
5.6; P < 0.001) and MACEs (HR:
2.3, 95%CI: 1.4-3.8; P < 0.001)
HR: Hazard ratio; OR: odds ratio; CI: confidence interval; STEMI: ST segment elevation myocardial infarction; TIMI: thrombolysis in myocardial
infarction; PPCI: primary percutaneous coronary intervention; IRA: infarct related artery; CAE: coronary artery ectasia; TCE: transcatheter coil
embolization; CAA: coronary artery aneurysm; CAPA: coronary artery pseudoaneurysm; DES: drug eluting stent; MLD: minimal lumen diameter;
DS: diameter stenosis; PCI: percutaneous coronary intervention; PTFE: polytetrafluoroethylene; CCS: coronary covered stent; TLR: target lesion
revascularization; ISR: in-stent restenosis; SVG: saphenous vein graft; CAP: coronary artery perforation; TV-MI: target vessel myocardial
infarction; TVO: target vessel occlusion; ST: stent thrombosis; TLF: target lesion failure; MACE: major adverse cardiovascular event(s); TVR:
target vessel revascularization; PSM: propensity score matching; CL: culprit lesion; MI: myocardial infarction; CHF: congestive heart failure; RCA:
right coronary artery; TTR: time in therapeutic range; DAPT: dual antiplatelet therapy; ACS: acute coronary syndromes; N/A: not applicable;
revasc: revascularization.

Surgical interventions
Surgical treatment of CAAs generally consists of resection or ligation of the aneurysm associated with
aortocoronary bypass . Surgery should be considered for giant aneurysms with a high likelihood of rupture
[74]
or compressing adjacent structures, in the presence of complications such as fistula formation, or when
coronary anatomy precludes percutaneous treatment [75,76] [Figure 2C and D].

CONCLUSION
Coronary artery aneurysms and ectasia are often asymptomatic and detected incidentally at coronary
angiography or CT-scan. However, they have been associated with clinical manifestations that mimic those
of ischemic heart disease, and with poor outcomes regardless of clinical presentation. Given the uncertainty
about pathogenesis, natural history, and optimal treatment strategy for CAA, multicenter registries are
warranted both to determine the prognosis of asymptomatic patients with CAAs/CAEs and to inform about
the outcome of each therapeutic approach. For the time being, given the lack of high-quality studies and
randomized trials, we suggest a patient-tailored treatment depending on the size, location, and morphology
of the aneurysm, clinical presentation, and patient’s comorbidities.

DECLARATIONS
Authors’ contributions
Contributed to the design of the paper, the literature review, and the writing of the manuscript: Barioli A,
Visco E
Supervised the project: Cernetti C, Favero L
Discussed the results and contributed to the final manuscript: Barioli A , Visco E, Pellizzari N, Marzot F,
Lanzellotti D, Favero L, Cernetti C

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.