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Coronary Artery Ectasia — EECC MCQ

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ModerateCoronary Artery DiseaseCoronary Artery EctasiaEECC

A 55-year-old woman presents with chest pain and troponin rise. Coronary angiography shows diffuse coronary artery ectasia of the RCA (diameter 7 mm, normal segment 3 mm) without focal stenosis. What is the diagnosis and management?

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Correct answer: B — Coronary artery ectasia — characterised by diffuse dilatation >1.5x the reference vessel diameter; management includes antiplatelet therapy with consideration of anticoagulation if severely ectatic due to thrombus risk

Coronary artery ectasia (CAE) is defined as diffuse or focal dilatation exceeding 1.5 times the adjacent normal segment diameter. It is associated with atherosclerosis (50%), connective tissue disease (Marfan, Ehlers-Danlos), Kawasaki disease (children), and vasculitis. The dilated segments promote turbulent flow, stasis, and thrombus formation, which can cause ACS (often STEMI via thrombus propagation into non-ectatic segments). Management includes: antiplatelet therapy (aspirin) for all CAE; anticoagulation (warfarin or DOAC) may be considered for severely ectatic or giant aneurysmal segments (>8 mm) due to thrombus risk; calcium channel blockers and nitrates for associated vasospasm.

Reference: ESC (2024): CCS Guidelines; AHA Scientific Statement on Coronary Aneurysms