Clinical case of coronary artery aneurysm

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Abstract

An aneurysm of a coronary artery is considered to be its expansion by 1.5 times or more over a short distance. The relevance of this pathology is determined by the severity of complications, mainly thrombotic. According to autopsies, it is detected in approximately 1.5% of all autopsies. In the majority of cases, coronary artery aneurysms are asymptomatic, but they also can cause symptoms similar to acute coronary syndrome. A rupture of the aneurysm is a rare but potentially dangerous complication of coronary artery aneurysm. The tactics of managing patients is determined by the severity of symptoms, aneurysm localization, the dynamics of the aneurysm, the presence of myocardial infarction in the area of the altered artery blood supply, the risk of surgical intervention, the distribution and degree of atherosclerotic changes in the coronary vessels, and the possibilities of drug therapy. Reliable diagnostic methods are coronary angiography and multidetector computed tomography. The paper describes a clinical case with patient G., aged 50, who was admitted to the emergency cardiology department with a typical picture of acute coronary syndrome, with stable hemodynamics and without echocardiographic signs of ischemia or infarction. An in-depth study of the coronary system was carried out in order to determine the prospects and the need for planned percutaneous coronary intervention. Computed tomography was performed for this purpose and revealed not only high degrees of stenosis in several coronary arteries, but also structural changes in the coronary system in the form of an aneurysm of the proximal segment of the anterior interventricular branch. The results obtained with computed tomography determined the need for coronary angiography. Its data made it possible to clarify the number, location and severity of stenotic changes in the coronary arteries, as well as to determine other localizations of aneurysms of the coronary system. The summary data of the two studies made it possible to establish that the patient had both stenosing atherosclerosis of the coronary arteries and multiple aneurysms of some arteries at the same time. It was deemed appropriate to continue conservative treatment aimed at preventing recurrence of acute coronary syndrome and thrombosis of coronary artery aneurysm, treatment of hypertension and secondary prevention of atherosclerosis. This clinical case demonstrates that the combined pathology of the coronary arteries can have clinical manifestations in the form of a single episode of acute coronary syndrome.

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About the authors

Elvira B. Zakirova

City Clinical Hospital No. 7; Institute of Fundamental Medicine and Biology, Kazan Federal University

Email: frolova.67@mail.ru
ORCID iD: 0000-0002-4653-1734

M.D., Cand. Sci. (Med.), Deputy Head; Assoc. Prof., Depart. of Clinical Diagnostics with the Course of Pediatrics

Russian Federation, Kazan, Russia; Kazan, Russia

Nykolay A. Tsybulkin

Kazan State Medical Academy, a branch of the Russian Medical Academy of Postgraduate Education

Email: ter-med@mail.ru
ORCID iD: 0000-0002-1343-0478

M.D., PhD, Assoc. Prof., Depart. of cardiology, rentgenendovascular and cardiovascular surgery

Russian Federation, Kazan, Russia

Leysan I. Gaynutdinova

City Clinical Hospital No. 7; Institute of Fundamental Medicine and Biology, Kazan Federal University

Author for correspondence.
Email: orgmetod.rkb3@mail.ru
ORCID iD: 0000-0002-5859-8776

M.D., Cand. Sci. (Med.), Head, HMT department; Assoc. Prof., Depart. of Preventive Medicine

Russian Federation, Kazan, Russia; Kazan, Russia

Galina V. Tukhvatullina

Medical and sanitary unit of the Ministry of Internal Affairs of Russia for the Republic of Tatarstan

Email: galatuhvatullina65@gmail.com
ORCID iD: 0000-0002-7949-0457

M.D., Head, Clinical diagnostic laboratory

Russian Federation, Kazan, Russia

Ayrat Z. Khairullin

City Clinical Hospital No. 7; Institute of Fundamental Medicine and Biology, Kazan Federal University

Email: drairatmrict@gmail.com
ORCID iD: 0000-0003-2560-1235

M.D., Radiologist, radiology depart.; Assistant, Depart. of Cli­nical Diagnostics with the Course of Pediatrics

Russian Federation, Kazan, Russia; Kazan, Russia

Sergey V. Kurochkin

City Clinical Hospital No. 7; Institute of Fundamental Medicine and Biology, Kazan Federal University

Email: kurochkin.70@bk.ru
ORCID iD: 0000-0002-8043-3871

M.D., Cand. Sci. (Med.), Head, radiology depart.; Assoc. Prof., Depart. of Clinical Diagnostics with the Course of Pediatrics

Russian Federation, Kazan, Russia; Kazan, Russia

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Supplementary files

Supplementary Files
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1. Рис. 1. Компьютерная томограмма, мультипланарная реконструкция. Фузиформная аневризма в средней трети огибающей ветви левой коронарной артерии с кальцинозом стенок и пристеночными концентрическими тромботическими массами (отмечена стрелкой)

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2. Рис. 2. Компьютерная томограмма. Фузиформная аневризма в средней трети огибающей ветви левой коронарной артерии с кальцинозом стенок и пристеночными концентрическими тромботическими массами (отмечена стрелкой)

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3. Рис. 3. Коронарная ангиография: а — аневризматическое расширение проксимального сегмента передней межжелудочковой ветви (в овале); б — аневризматическое расширение проксимального и медиального сегментов огибающей ветви (сплошные стрелки); в — аневризматическое расширение на всём протяжении (сплошные стрелки), стеноз медиального сегмента 60% (пунктирная стрелка) правой коронарной артерии

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