Prevalence of Coronary Artery Ectasia in Patients with Ascending Aortic Aneurysm: A Retrospective Observational Study

Abstract

Aim: Coronary artery ectasia (CAE) is a rare coronary artery anomaly defined as dilation of a coronary artery segment to at least 1.5 times the diameter of the adjacent normal segment. Structural abnormalities of the vascular wall are thought to be associated with aortic aneurysms. This study, aimed to determine the prevalence of coronary artery ectasia in patients operated for ascending aortic aneurysm and to evaluate the relationship between aneurysm diameter and the presence of coronary ectasia and coronary flow characteristics. Methods: This retrospective observational study included patients who underwent surgery for ascending aortic aneurysm between 2015 and 2025 and who had preoperative coronary angiography. Demographic characteristics, cardiovascular risk factors, aneurysm diameter and angiographic findings were recorded. Coronary artery ectasia was defined as dilation exceeding 1.5 times the diameter of the adjacent normal segment and was classified according to the Markis classification. The coronary slow flow phenomenon was evaluated using the TIMI frame count method. Clinical and angiographic characteristics were compared according to the presence of ectasia and factors predicting ectasia were analyzed using logistic regression analysis. Results: A total of 115 patients were included in the study and coronary artery ectasia was detected in 36 patients (31.3%). The mean age of patients with ectasia was significantly higher than those without ectasia (63.6 ± 9.5 vs. 58.9 ± 10.8 years; p=0.026). An inverse relationship was found between ascending aortic diameter and the presence of coronary ectasia (p=0.048). In multivariate logistic regression analysis, age was shown to be an independent predictor of coronary ectasia. Coronary ectasia was most frequently detected in the right coronary artery, while Markis type I and type III were the most common ectasia types. In addition, the presence of coronary ectasia was observed to be associated with the coronary slow flow phenomenon. Conclusion: Coronary artery ectasia is observed more frequently in patients with ascending aortic aneurysm compared with the general coronary angiography population. Advanced age appears to be independently associated with the presence of coronary ectasia. In addition, the presence of coronary ectasia is associated with the coronary slow flow phenomenon, suggesting that coronary hemodynamic alterations may play a role in this patient population.

Keywords

• coronary artery ectaia
• ascending aortic aneurysm
• coronary slow flow

Asenden Aort Anevrizması Olanlarda Koroner Arter Ektazisi yaygınlığı: Retrospektif Gözlemsel Çalışma

Öz

Amaç: Koroner arter ektazisi (KAE), koroner arterin komşu normal segmente göre en az 1,5 kat genişlemesi olarak tanımlanan nadir bir koroner arter anomalisidir. Vasküler duvar yapısındaki bozuklukların aort anevrizmaları ile ilişkili olabileceği düşünülmektedir. Bu çalışmada asendan aort anevrizması nedeniyle opere edilen hastalarda koroner arter ektazisi prevalansının belirlenmesi ve anevrizma çapı ile koroner ektazi varlığı ve koroner akım özellikleri arasındaki ilişkinin değerlendirilmesi amaçlandı. Yöntem: Bu retrospektif gözlemsel çalışmaya 2015–2025 yılları arasında asendan aort anevrizması nedeniyle opere edilen ve operasyon öncesi koroner anjiyografisi bulunan hastalar dahil edildi. Demografik özellikler, kardiyovasküler risk faktörleri, anevrizma çapı ve anjiyografik bulgular kaydedildi. Koroner arter ektazisi, komşu normal segment çapının 1,5 katından fazla genişleme olarak tanımlandı ve Markis sınıflamasına göre sınıflandırıldı. Koroner yavaş akım fenomeni TIMI frame count yöntemi kullanılarak değerlendirildi. Ektazi varlığına göre klinik ve anjiyografik özellikler karşılaştırıldı ve ektaziyi öngören faktörler lojistik regresyon analizi ile incelendi. Bulgular: Çalışmaya toplam 115 hasta dahil edildi ve 36 hastada koroner arter ektazisi saptandı (%31,3). Ektazi bulunan hastaların yaş ortalaması ektazi olmayan gruba göre anlamlı düzeyde daha yüksek bulundu (63,6 ± 9,5 vs. 58,9 ± 10,8 yıl; p=0,026). Asendan aort çapı ile koroner ektazi varlığı arasında ters yönlü bir ilişki bulundu (p=0,048). Çok değişkenli lojistik regresyon analizinde yaşın koroner ektazi için bağımsız bir belirleyici olduğu gösterildi. Koroner ektazi en sık sağ koroner arterde saptanırken Markis tip I ve tip III en sık görülen ektazi tipleri oldu. Ayrıca koroner ektazi varlığının koroner yavaş akım fenomeni ile ilişkili olduğu gözlendi. Sonuç: Asendan aort anevrizması olan hastalarda koroner arter ektazisi genel koroner anjiyografi popülasyonuna kıyasla daha yüksek sıklıkta görülmektedir. İleri yaş koroner ektazi varlığı ile bağımsız olarak ilişkili görünmektedir. Ayrıca koroner ektazi varlığı koroner yavaş akım fenomeni ile ilişkilidir ve bu durum bu hasta grubunda koroner hemodinamik değişikliklerin rol oynayabileceğini düşündürmektedir.

Anahtar Kelimeler

• koroner arter ektazisi
• asenden aort anevrizması
• koroner yavaş akım

Kaynakça

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