Coronary artery ectasia (CAE) is a relatively rare disease wherein there is diffuse dilatation of the coronary artery, defined as more than or equal to  1.5x the diameter of the adjacent normal coronary segment. Its prevalence ranges from 0.3% to 4.3%,  and is typically identified incidentally during coronary angiograms performed for other indications. Despite being asymptomatic in most of the cases, this condition can eventually present with angina or abnormal exercise stress tests, or even life threatening conditions such as acute coronary syndrome (ACS). 

In order to shed light for this condition, our case is a 59-year-old Filipino male with hypertension who presented to the ER with inferior and lateral wall ST elevation myocardial infarction (STEMI). Urgent coronary angiography showed total occlusion of the mid-right coronary artery and extensive CAE in multiple vessels, with coronary diameters up to 6.0 cm. Balloon angioplasty and aspiration thrombectomy restored TIMI 2 flow and patient was given intravenous tirofiban for 24 hours, followed by triple antithrombotic therapy (Aspirin 80mg once a day, Clopidogrel 75mg once a day and Rivaroxaban 2.5mg twice a day), then was eventually given clopidogrel and rivaroxaban. He remained asymptomatic at 6-month and 1-year  follow-ups, with a repeat coronary angiogram with intravenous ultrasound or optical coherent tomography discussed.

 

Since there are no standard treatment specific for CAE itself, our case highlighted the challenges of managing CAE, especially in ACS patients. Key challenges observed in the patient included techniques in performing percutaneous coronary intervention to include aspiration thrombectomy,  subsequent appropriate antithrombotic and anticoagulation and follow-up strategies such as IVUS or OCT. With the growing availability of coronary angiography, it is anticipated that CAE will be increasingly identified especially in ACS patients. This highlights the need for guidelines to reduce recurrence and major adverse cardiovascular events considering its management complexities 

Dr. Kenneth Rey-Matias is currently the Chief Cardiology Fellow at Perpetual Help Medical Center Las Piñas, Philippines. He will complete his fellowship training in adult cardiology by March 2025 and is scheduled to take the Specialty Board in Adult Cardiology in April 2026. He plans to pursue further subspecialization through a clinical research fellowship in interventional cardiology, aspiring to become a leader in the field. 

His research interests focus primarily on lipid profiles, coronary angiogram findings, and acute coronary syndrome management, including specialized conditions such as coronary artery ectasia.