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Ivan J Nunezgil - One of the best experts on this subject based on the ideXlab platform.

  • Coronary Artery Aneurysms insights from the international Coronary Artery Aneurysm registry caar
    International Journal of Cardiology, 2020
    Co-Authors: Ivan J Nunezgil, Luis Nombelafranco, Mario Bollati, Enrico Cerrato, Belen Terol, Emilio Alfonsorodriguez, Santiago Jesus Camacho Freire, Pedro A Villablanca, Ignacio Amat J Santos
    Abstract:

    Abstract Background Coronary Aneurysms are a focal dilatation of an Artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3–12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. Methods and results The Coronary Artery Aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004–2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute Coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with Coronary stenosis. Aortopathies were related with more Aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. Conclusions Coronary Artery Aneurysms are not uncommon. Usually, they are associated with Coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.

  • rationale and design of a multicenter international and collaborative Coronary Artery Aneurysm registry caar
    Clinical Cardiology, 2017
    Co-Authors: Ivan J Nunezgil, Luis Nombelafranco, Rodrigo Bagur, Mario Bollati, Enrico Cerrato, Emilio Alfonso, Christoph Liebetrau, Jose M De La Torre Hernandez, Benjamin Camacho, Rafael Mila
    Abstract:

    Coronary Artery Aneurysm is defined as a Coronary dilation that exceeds the diameter of adjacent segments or the diameter of the patient's largest normal Coronary vessel by 1.5×. It is an uncommon disease that has been diagnosed with increasing frequency since the widespread appearance of Coronary angiography. The published incidence varies from 1.5% to 5%, suggesting male dominance and a predilection for the right Coronary Artery. Although several causes have been described, atherosclerosis accounts for ≥50% of Coronary Aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture, and vasospasm, causing ischemia, heart failure, or arrhythmias. The natural history and prognosis remain unknown, as definitive data are scarce. Controversies persist regarding the use of medical management (antithrombotic therapy) or interventional/surgical procedures. Only some case reports or small case series are available about this condition. The Coronary Artery Aneurysm Registry (CAAR; http://www.ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT02563626","term_id":"NCT02563626"}}NCT02563626) is a multicenter international ambispective registry that aims to provide insights on anatomic, epidemiologic, and clinical aspects of this substantially unknown entity. In addition, the registry will assess management strategies (conservative, interventional, or surgical) and their short‐ and long‐term results in a large cohort of patients. Clinical Trial registration: ClinicalTrials.gov. Unique identifier: {"type":"clinical-trial","attrs":{"text":"NCT02563626","term_id":"NCT02563626"}}NCT02563626.

Xuebo Liu - One of the best experts on this subject based on the ideXlab platform.

Yu Luo - One of the best experts on this subject based on the ideXlab platform.

Ignacio Amat J Santos - One of the best experts on this subject based on the ideXlab platform.

  • Coronary Artery Aneurysms insights from the international Coronary Artery Aneurysm registry caar
    International Journal of Cardiology, 2020
    Co-Authors: Ivan J Nunezgil, Luis Nombelafranco, Mario Bollati, Enrico Cerrato, Belen Terol, Emilio Alfonsorodriguez, Santiago Jesus Camacho Freire, Pedro A Villablanca, Ignacio Amat J Santos
    Abstract:

    Abstract Background Coronary Aneurysms are a focal dilatation of an Artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3–12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. Methods and results The Coronary Artery Aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004–2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute Coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with Coronary stenosis. Aortopathies were related with more Aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. Conclusions Coronary Artery Aneurysms are not uncommon. Usually, they are associated with Coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.

Chihyuan Fang - One of the best experts on this subject based on the ideXlab platform.

  • fistulae ligation and left main Artery ligation for a bilateral giant Coronary arterial fistulae related Aneurysm
    European Journal of Cardio-Thoracic Surgery, 2019
    Co-Authors: Haoyi Hsiao, Weichieh Lee, Jiunnjye Sheu, Chihyuan Fang
    Abstract:

    Bilateral congenital Coronary Artery fistulae complicated with a giant Coronary Artery Aneurysm is a very rare condition. A Coronary Artery Aneurysm is a Coronary Artery dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest Coronary vessel by 1.5 times. The complications associated with a Coronary Artery Aneurysm include thrombosis, embolization, rupture, vasospasm, congestive heart failure and infectious endocarditis. We report on a 63-year-old woman presenting with severe heart failure related to bilateral Coronary Artery fistulae. A giant Coronary Aneurysm was noted in the right Coronary Artery, and a tortuous Coronary Artery fistula was noted in the left Coronary Artery. Symptoms were relieved after surgical intervention for bilateral Coronary Artery fistulae.

  • clinical features and outcome of Coronary Artery Aneurysm in patients with acute myocardial infarction undergoing a primary percutaneous Coronary intervention
    The Cardiology, 2002
    Co-Authors: Honkan Yip, Chihyuan Fang, Miencheng Chen, Chiling Hang, Kelvin Hsieh, Kuoho Yeh
    Abstract:

    Background: While Coronary Artery Aneurysm is an uncommon anatomic disorder and has various forms, its clinical features and outcome and its impact on thrombus formation and the no-reflow phenomenon in the clinical setting of acute myocardial infarction (AMI) undergoing primary percutaneous Coronary intervention (p-PCI) have not been discussed. The purpose of this study was to evaluate whether this anatomic disorder predisposes to a high burden of thrombus formation, and subsequently leads to the no-reflow phenomenon and untoward clinical outcome in patients with AMI undergoing p-PCI. Methods and Results: In our hospital, emergency p-PCI was performed in 924 consecutive patients with AMI between May 1993 and July 2001. Of these 924 patients, 24 patients (2.6%) who had an infarct-related Artery (IRA) with Aneurysmal dilatation were retrospectively registered and constituted the patient population of this study. Angiographic findings demonstrated that the ectasia type (defined as diffuse dilatation of 50% or more of the length of the IRA) was found most frequently (70%), followed by the fusiform type (20%; defined as a spindle-shaped dilatation in the IRA) and the saccular type (10%; defined as a localized spherical-shaped dilatation in the IRA). The right Coronary Artery was the most frequently involved vessel (54.2%), followed by the left anterior descending (25.0%) and the left circumflex arteries (20.8%). Coronary angiography revealed that all of these Aneurysmal IRA filled with heavy thrombus (indicated as high-burden thrombus formation). The no-reflow phenomenon (defined as ≤TIMI-2 flow) and distal embolization after p-PCI were found in 62.5 and 70.8% of the IRA, respectively. The incidence of cardiogenic shock and the 30-day mortality rate were 25 and 8.3%, respectively. The survival rate was 90.9% (20/22) during a mean follow-up of 19 ± 30 months. Conclusions: While Aneurysmal dilatation of an IRA is an uncommon angiographic finding in the clinical setting of AMI, it is frequently associated with high-burden thrombus formation and has a significantly lower incidence of successful reperfusion. However, the long-term survival of these patients is excellent.