Koroner Arter Anevrizmalı Hastalarda Koroner Aterosklerozun MDBT Anjiyografi Kullanılarak CAD-RADS Skorlama Sistemi ile Değerlendirilmesi

Öz

Amaç: Bu makale koroner arter hastalığı ön tanısı ile koroner Multidedektör Bilgisayarlı Tomografi (MDBT) Anjiyografi yapılan ve koroner arter anevrizması (KAA) saptanan hastalarda, ‘’Coronary Artery Disease Raporting And Data System’’ (CAD-RADS) sınıflaması ile aterosklerozun derecesini ve sıklığını araştırmak ve ayrıca KAA’da predispozan faktörleri, yaygınlığını, tanı kriterlerini ve komplikasyonlarını BT görünümleri eşliğinde ele almaktır.
Materyal ve Metot: Koroner MDBT Anjiyografi çekilen 3694 hastanın tetkiklerini retrospektif olarak inceledik. KAA tespit edilen 23 hasta ile birlikte KAA bulunmayan 46 hasta dahil toplam 69 hastayı aterosklerotik tutulum açısından CAD-RADS sınıflama sistemini kullanarak değerlendirdik ve bulguları karşılaştırdık.
Bulgular: KAA en sık sağ koroner arterde (RCA) bulunurken, bunu sol anterior desendan arter (LAD), sol sirkümfleks (LCX), sol ana koroner arter (LMCA) ve posterolateral dal (PLD) izledi. KAA olan hastalarda en sık ateroskleroz görülen damarlar sırasıyla LAD, LCX, RCA ve LMCA iken anevrizması olmayan hastalarda LAD, RCA, LCX, LMCA, PLD ve PDA olarak tespit edildi. KAA olan 5 hastada (21.7 %) ve olmayan 15 hastada (32.6 %) ateroskleroz saptanmadı (p>0.05).
Sonuç: KAA’lı hastalarda CAD-RADS skorlaması kullanılarak hesaplanan aterosklerotik damar sayısı ve darlık derecesi, anevrizması olmayan hastalar ile benzerdir.

Anahtar Kelimeler

• Koroner arter anevrizması
• koroner ateroskleroz
• MDBT anjiyografi

Evaluation of Coronary Atherosclerosis in Patients with Coronary Artery Aneurysm With CAD-RADS Scoring System Using MDCT Angiography

Öz

Aim: This article aims to investigate the degree and frequency of atherosclerosis using the “Coronary Artery Disease Reporting and Data System” (CAD-RADS) classification in patients who underwent coronary Multidetector Computed Tomography (MDCT) Angiography with a preliminary diagnosis of coronary artery disease and were found to have coronary artery aneurysm (CAA) and also to discuss the predisposing factors, prevalence, diagnostic criteria and complications in CAA with CT images.
Material and Methods: We retrospectively evaluated the examinations of 3694 patients who underwent coronary MDCT angiography. We evaluated a total of 69 patients including 23 patients with CAA and 46 patients without CAA, in terms of atherosclerotic involvement using the CAD-RADS classification system and compared the findings.
Results: CAA was most frequently found in the right coronary artery (RCA), followed by the left anterior descending artery (LAD), left circumflex (LCX), left main coronary artery (LMCA), and posterolateral branch (PLB). In patients with CAA, the most frequently atherosclerosis observed vessels were LAD, LCX, RCA, and LMCA, respectively, while LAD, RCA, LCX, LMCA, PLD, and PDA were detected in patients without an aneurysm. No atherosclerosis was detected in 5 patients (21.7 %) with CAA and 15 patients (32.6 %) without CAA (p>0.05).
Conclusion: The number of atherosclerotic vessels and the degree of stenosis calculated using the CAD-RADS scoring in patients with CAA are similar to patients without an aneurysm. The fact that atherosclerosis is an important factor in the etiology of aneurysms may explain this situation.  

Anahtar Kelimeler

• Coronary artery aneurysm
• coronary atherosclerosis
• MDCT angiography

Kaynakça

1. References 1. Jarcho S. Bougon on coronary aneurysm (1812). Am J Cardiol 1969; 24:551–3.
2. 2. Kawsara A, Núñez Gil IJ, Alqahtani F, Moreland J, Rihal CS, Alkhouli M: Management of coronary artery aneurysms. JACC Cardiovasc Interv. 2018, 11:1211-23. 10.1016/j.jcin.2018.02.041
3. 3. Hartnell GG, Parnell BM, Pridie RB: Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J. 1985, 54:392-5. 10.1136/hrt.54.4.392
4. 4. Rukhsan S, Nuzhat S, Ishaq M, et al. The prevalence and clinical profile of angiographic coronary ectasia. J Pakistan Med Assoc 2011; 61:372–5.
5. 5.Luo Y, Tang J, Liu X, Qiu J, Ye Z, Lai Y, Yao Y, Li J, Wang X. Coronary Artery Aneurysm Differs From Coronary Artery Ectasia: Angiographic Characteristics and Cardiovascular Risk Factor Analysis in Patients Referred for Coronary Angiography. Angiology 2017; 68: 823-830 [PMID: 27568385 DOI: 10.1177/0003319716665690]
6. 6. Kawsara A, Núñez Gil IJ, Alqahtani F, Moreland J, Rihal CS, Alkhouli M. Management of Coronary Artery Aneurysms. JACC Cardiovasc Interv 2018; 11: 1211-1223 [PMID: 29976357 DOI: 10.1016/j.jcin.2018.02.041]
7. 7. Manginas A, Cokkinos DV. Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur Heart J 2006; 27: 1026-1031 [PMID: 16415301 DOI: 10.1093/eurheartj/ehi725]
8. 8. Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography 2004; 21: 175-182 [PMID: 14961799 DOI: 10.1111/j.0742-2822.2004.03050.x]

9. 9. Ye Z, Dong XF, Yan YM, Luo YK. Coronary artery aneurysm combined with myocardial bridge: A case report. World J Clin Cases 2021; 9(16): 3996-4000
10. 10. Ali Dahhan. Coronary artery ectasia in atherosclerotic coronary artery disease, inflammatory disorders, and sickle cell disease. Cardiovasc Ther 2015;33:79–88.
11. 11. Cohen P, O’Gara PT. Coronary artery aneurysms: a review of natural history, pathophysiology, and management. Cardiol Rev 2008; 16:301–304
12. 12. Matta AG, Yaacoub N, Nader V, Moussallem N, Carrie D, Roncalli J. Coronary artery aneurysm: A review. World J Cardiol 2021; 13(9): 446-455
13. 13. Pamela T. Johnson1, Elliot K. Fishman. CT Angiography of Coronary Artery Aneurysms: Detection, Definition, Causes, and Treatment AJR 2010; 195:928–934.
14. 14. Al-Zakhari R, Aljammali S, Galligan S, et al. (April 12, 2021) Coronary Artery Ectasia: A Case Report Discussing the Causes, Diagnosis, and Treatment. Cureus 13(4): e14431. DOI 10.7759/cureus.14431
15. 15. Parveen Kumar at al. J Cardiovasc Imaging. 2022 Jan;30(1):1-24 https://doi.org/10.4250/jcvi.2020.0195 pISSN 2586-7210•eISSN 2586-7296
16. 16. Cury RC, Abbara S, Achenbach S, et al. CAD-RADS(TM) Coronary Artery Disease - Reporting and Data System. An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Radiology (ACR) and the North American Society for Cardiovascular Imaging (NASCI). Endorsed by the American College of Cardiology. J Cardiovasc Comput Tomogr 2016;10(4):269–281.
17. 17. Basha MAA, Aly SA, Ismail AAA, Bahaaeldin HA, Shehata SM. The validity and applicability of CAD-RADS in the management of patients with coronary artery disease. Insights Imaging 2019;10(1):117.
18. 18. Angelo K. Takigami, at al. Coronary Artery Disease Reporting and Data System (CAD-RADS) Adoption: Analysis of Local Trends in a Large Academic Medical Center Radiology: Cardiothoracic Imaging 2021; 3(3): e210016 https://doi.org/ 10.1148/ryct.2021210016
19. 19. Pahlavan PS, Niroomand F. Coronary artery aneurysm: a review. Clin Cardiol 2006; 29:439–43.
20. 20. Swaye PS, Fisher LD, Litwin P, et al.: Aneurysmal coronary artery disease . Circulation. 1983, 67:134-8. 10.1161/01.cir.67.1.134
21. 21. Abou Sherif S, Ozden Tok O, Tas¸köylü Ö, et al. Coronary artery aneurysms: a review of the epidemiology, pathophysiology, diagnosis, and treatment. Front Cardiovasc Med 2017; 4:24.
22. 22. Devabhaktuni S, Mercedes A, Diep J, Ahsan C. Coronary Artery Ectasia-A Review of Current Literature. Curr Cardiol Rev 2016; 12: 318-323 [PMID: 27142049 DOI: 10.2174/1573403X12666160504100159]
23. 23. Li-Cheng Jiang, MS, Jia-Yu Cao, MD, Mao Chen, MD, PhD Coronary artery aneurysm combined with other multiple aneurysms at multiple locations Medicine (2017) 96:50(e9230)
24. 24. Kang SH, Park GM, Lee SW, et al. Long-term prognostic value of coronary CT angiography in asymptomatic type 2 diabetes mellitus. JACC Cardiovasc Imaging 2016; 9:1292-300.
25. 25. Kanamaru H, Sato Y, Takayama T, et al. Assessment of coronary artery abnormalities by multislice spiral computed tomography in adolescents and young adults with Kawasaki disease. Am J Cardiol 2005; 95:522–525
26. 26. Chu WC, Mok GC, Lam WW, Yam MC, Sung RY. Assessment of coronary artery aneurysms in pediatric patients with Kawasaki disease by multidetector row CT angiography: feasibility and comparison with 2D echocardiography. Pediatr Radiol 2006; 36:1148–1153
27. 27. van Stijn-Bringas Dimitriades D, Planken N, Kuipers I, Kuijpers T. CT Angiography or Cardiac MRI for Detection of Coronary Artery Aneurysms in Kawasaki Disease. Front Pediatr 2021; 9: 630462 [PMID: 33614558 DOI: 10.3389/fped.2021.630462]
28. 28. Xie JX, Cury RC, Leipsic J, et al. The coronary artery disease-reporting and data system (CAD-RADS): prognostic and clinical implications associated with standardized coronary computed tomography angiography reporting. JACC Cardiovasc Imaging 2018; 11:78-89.
29. 29. Nam K, Hur J, Han K, et al. Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke. Atherosclerosis 2019; 287:1-7.
30. 30. Bittner DO, Mayrhofer T, Budoff M, et al. Prognostic value of coronary CTA in stable chest pain: CAD-RADS, CAC, and cardiovascular events in PROMISE. JACC Cardiovasc Imaging 2020; 13:1534-45.
31. 31. Swaye PS, Fisher LD, Litwin P, et al. Aneurysmal coronary artery disease. Circulation 1983; 67:134–8.
32. 32. George H, Barbara P, Pridie RB. Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. Br Heart J 1985; 54:392–5.
33. 33. Göran Bergström at al. Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population. Circulation. 2021; 144:916–929. DOI: 10.1161/CIRCULATIONAHA.121.055340
34. 34. Azza Farrag, Amr El Faramawy, Mohammed Ali Salem, Rabab Abdel Wahab & Soliman Ghareeb Coronary artery ectasia diagnosed using multidetector computed tomography: morphology and relation to coronary artery calcification.The International Journal of Cardiovascular Imaging 2013; volume 29, pages427–433