5 Similarly, there has been no large study examining the prevalence of giant CAA, though available data suggest that approximately 0.2% of patients undergoing coronary angiography may have a giant CAA. There is no universally accepted definition of a giant CAA however, one of the largest CAA studies defined giant CAA as an aneurysm size of greater than 4 times the reference vessel size. 2 This is likely due to the complexity of endovascular intervention in a giant CAA, as well as surgical success in excising giant coronary aneurysm sacs.
A review by Boyer et al 1 proposes an algorithmic approach taking into account both clinical and angiographic factors in determining treatment strategy, though this is predominantly based on case series and expert opinion.Ī giant CAA can present a unique clinical challenge, and surgery has been suggested as the preferred treatment. 2 – 4 However, there are no current guidelines on optimal revascularization approaches.
1 Beyond medical therapy, symptomatic CAA patients have often required a variety of novel revascularization approaches, including covered stents, surgical approaches, and coil embolization. In addition to standard dual antiplatelet therapy for ACS, these patients often also require anticoagulation therapy. Coronary artery aneurysms (CAA) are a rare cause of acute coronary syndrome (ACS) with a distinct mechanism of myocardial infarction the low flow state within the aneurysm sac is prone to thrombus formation and subsequent distal embolization.