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Ahmed JA, Ahmed KA, Ahmed MH. Ranolazine as a First-Choice Anti-anginal Medication for Patients With Coronary Artery Ectasia: A Case Series. Cureus 2024; 16:e52747. [PMID: 38384654 PMCID: PMC10881230 DOI: 10.7759/cureus.52747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/23/2024] Open
Abstract
Coronary artery ectasia (CAE) is characterized by the abnormal dilation of coronary arteries, resulting in disturbed or slow blood flow, which causes angina pectoris-the most prevalent symptom of CAE. To date, there is no consensus on the therapeutic management of CAE due to its rarity and the scarcity of research. We present a case series of five patients with different ethnicities, including both men and women, whose CAE was successfully managed by the administration of ranolazine. All five patients were found to have CAE by coronary angiography, which was also associated with slow blood flow. Clinically, the patients had accelerating angina. They were prescribed an initial dose of 500 mg of ranolazine twice daily, which led to the resolution of their anginal symptoms. They have been clinically and hemodynamically stable for the last several years. In light of these results, we propose that ranolazine be considered as a first-choice anti-anginal medication for patients with CAE.
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Coronary Artery Ectasia: Review of the Non-Atherosclerotic Molecular and Pathophysiologic Concepts. Int J Mol Sci 2022; 23:ijms23095195. [PMID: 35563583 PMCID: PMC9103542 DOI: 10.3390/ijms23095195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Coronary artery ectasia (CAE) is frequently encountered in clinical practice, conjointly with atherosclerotic CAD (CAD). Given the overlapping cardiovascular risk factors for patients with concomitant CAE and atherosclerotic CAD, a common underlying pathophysiology is often postulated. However, coronary artery ectasia may arise independently, as isolated (pure) CAE, thereby raising suspicions of an alternative mechanism. Herein, we review the existing evidence for the pathophysiology of CAE in order to help direct management strategies towards enhanced detection and treatment.
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Liu RF, Gao XY, Liang SW, Zhao HQ. Antithrombotic treatment strategy for patients with coronary artery ectasia and acute myocardial infarction: A case report. World J Clin Cases 2022; 10:3936-3943. [PMID: 35647140 PMCID: PMC9100716 DOI: 10.12998/wjcc.v10.i12.3936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/19/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is no consensus on the antithrombotic treatment strategy for patients with coronary artery ectasia (CAE).
CASE SUMMARY This case reports the dynamic observation of a patient for 48 mo after a diagnosis of CAE with acute myocardial infarction (AMI). The first antithrombotic agents used were aspirin (100 mg/d) and clopidogrel (75 mg/d). During the sixth month of observation, a second AMI occurred involving the same culprit vessel; therefore, antithrombotic agents were changed to aspirin (100 mg/d) and ticagrelor (90 mg twice per day). Twelve months after the second AMI, an attempt to reduce the dosage ticagrelor failed; therefore the original dose was continued. The CAE was relatively stable during the following 4 years.
CONCLUSION This case indicates that a combination of aspirin and ticagrelor may be more effective for CAE patients with AMI than aspirin and clopidogrel.
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Affiliation(s)
- Rui-Feng Liu
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Xiang-Yu Gao
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Si-Wen Liang
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Hui-Qiang Zhao
- Department of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
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Vrachatis DA, Papathanasiou KA, Kazantzis D, Sanz-Sánchez J, Giotaki SG, Raisakis K, Kaoukis A, Kossyvakis C, Deftereos G, Reimers B, Avramides D, Siasos G, Cleman M, Giannopoulos G, Lansky A, Deftereos S. Inflammatory Biomarkers in Coronary Artery Ectasia: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051026. [PMID: 35626182 PMCID: PMC9140118 DOI: 10.3390/diagnostics12051026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/10/2022] [Accepted: 04/14/2022] [Indexed: 12/23/2022] Open
Abstract
Isolated coronary artery ectasia (CAE) is a relatively rare clinical entity, the pathogenesis of which is poorly understood. More and more evidence is accumulating to suggest a critical inflammatory component. We aimed to elucidate any association between neutrophil to lymphocyte ratio and coronary artery ectasia. A systematic MEDLINE database, ClinicalTrials.gov, medRxiv, Scopus and Cochrane Library search was conducted: 50 studies were deemed relevant, reporting on difference in NLR levels between CAE patients and controls (primary endpoint) and/or on high-sensitive CRP, IL-6, TNF-a and RDW levels (secondary endpoint), and were included in our final analysis. (PROSPERO registration number: CRD42021224195). All inflammatory biomarkers under investigation were found higher in coronary artery ectasia patients as compared to healthy controls (NLR; SMD = 0.73; 95% CI: 0.27–1.20, hs-CRP; SMD = 0.96; 95% CI: 0.64–1.28, IL-6; SMD = 2.68; 95% CI: 0.95–4.41, TNF-a; SMD = 0.50; 95% CI: 0.24–0.75, RDW; SMD = 0.56; 95% CI: 0.26–0.87). The main limitations inherent in this analysis are small case-control studies of moderate quality and high statistical heterogeneity. Our findings underscore that inflammatory dysregulation is implicated in coronary artery ectasia and merits further investigation.
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Affiliation(s)
- Dimitrios A. Vrachatis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (D.K.); (S.G.G.); (G.S.)
| | - Konstantinos A. Papathanasiou
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (D.K.); (S.G.G.); (G.S.)
| | - Dimitrios Kazantzis
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (D.K.); (S.G.G.); (G.S.)
| | - Jorge Sanz-Sánchez
- Division of Cardiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain;
- Centro de Investigacion Biomédica en Red (CIBERCV), 28029 Madrid, Spain
| | - Sotiria G. Giotaki
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (D.K.); (S.G.G.); (G.S.)
| | - Konstantinos Raisakis
- Deparment of Cardiology, General Hospital of Athens “G.Gennimatas”, 11527 Athens, Greece; (K.R.); (A.K.); (C.K.); (G.D.); (D.A.)
| | - Andreas Kaoukis
- Deparment of Cardiology, General Hospital of Athens “G.Gennimatas”, 11527 Athens, Greece; (K.R.); (A.K.); (C.K.); (G.D.); (D.A.)
| | - Charalampos Kossyvakis
- Deparment of Cardiology, General Hospital of Athens “G.Gennimatas”, 11527 Athens, Greece; (K.R.); (A.K.); (C.K.); (G.D.); (D.A.)
| | - Gerasimos Deftereos
- Deparment of Cardiology, General Hospital of Athens “G.Gennimatas”, 11527 Athens, Greece; (K.R.); (A.K.); (C.K.); (G.D.); (D.A.)
| | - Bernhard Reimers
- Humanitas Clinical and Research Center IRCCS, 20089 Milan, Italy;
| | - Dimitrios Avramides
- Deparment of Cardiology, General Hospital of Athens “G.Gennimatas”, 11527 Athens, Greece; (K.R.); (A.K.); (C.K.); (G.D.); (D.A.)
| | - Gerasimos Siasos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (D.K.); (S.G.G.); (G.S.)
| | - Michael Cleman
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; (M.C.); (A.L.)
| | - George Giannopoulos
- Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA; (M.C.); (A.L.)
| | - Spyridon Deftereos
- Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.A.V.); (K.A.P.); (D.K.); (S.G.G.); (G.S.)
- Correspondence: ; Tel.: +30-2105832355
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