Coronary artery ectasia: a therapeutic dilemma

Coronary artery ectasia (CAE) is an abnormal dilatation of the coronary artery wall. The growing number of coronary angiographies and other invasive cardiologic procedures increased the documented incidence of CAE. There is no consensus about the etiology, prognostic significance and morbidity related to this phenomenon. Atherosclerosis is most probably the main cause of primary or idiopathic ectasia. In addition, it is postulated that chronic exposure to vasodilatatory substances, and therapeutic angioplastic procedures may mediate secondary ectasia. CAE is associated with increased coronary morbidity such as coronary spasm, dissection and thrombus formation. However, its relative contribution to coronary morbidity remains unclear. This uncertainty underlies the current dispute regarding the appropriate management and treatment of patients with CAE. Further studies including prospective therapeutic trials are needed to provide answers to these pending complex questions.