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      Left main coronary artery aneurysm occlusion presenting as myocardial infarction with cardiogenic shock: Patient saved by securing left anterior descending artery at cost the of other vessels

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          Key Clinical Message

          Coronary artery aneurysms and ST‐segment elevation myocardial infarction are rare in clinical practice, presenting a management challenge. To the best of our knowledge, this case appears to be the first successful percutaneous treatment of a completely obstructed aneurysmal left main coronary artery.

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          Most cited references12

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          Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment

          Coronary artery aneurysms (CAAs) are uncommon and describe a localized dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. The incidence of CAAs varies from 0.3 to 5.3%. Ever since the dawn of the interventional era, CAAs have been increasingly diagnosed on coronary angiography. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the management of CAAs, and emerging findings support the importance of an early diagnosis in patients predisposed to CAAs, such as in children with KD. This review aims to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of this disease.
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            Aneurysmal coronary artery disease: An overview

            Aneurysmal coronary artery disease (ACAD) comprises both coronary artery aneurysms (CAA) and coronary artery ectasia (CAE). The reported prevalence of ACAD varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery (RCA). Atherosclerosis is the commonest cause of ACAD in adults, while Kawasaki disease is the commonest cause in children and adolescents, as well as in the Far East. Most patients are asymptomatic, but when symptoms do exist, they are usually related to myocardial ischemia. Coronary angiography is the mainstay of diagnosis, but follow up is best achieved using noninvasive imaging that does not involve exposure to radiation. The optimal management strategy in patients with ACAD remains controversial. Medical therapy is indicated for the vast majority of patients and includes antiplatelets and/or anticoagulants. Covered stents effectively limit further expansion of the affected coronary segments. Surgical ligation, resection, and coronary artery bypass grafting are appropriate for large lesions and for associated obstructive coronary artery disease.
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              Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR)

              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.
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                Author and article information

                Contributors
                sharadaiims@gmail.com
                Journal
                Clin Case Rep
                Clin Case Rep
                10.1002/(ISSN)2050-0904
                CCR3
                Clinical Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2050-0904
                12 July 2024
                July 2024
                : 12
                : 7 ( doiID: 10.1002/ccr3.v12.7 )
                : e9036
                Affiliations
                [ 1 ] Department of Cardiology King George's Medical University Lucknow Uttar Pradesh India
                [ 2 ] Sarojini Naidu Medical College Agra Uttar Pradesh India
                Author notes
                [*] [* ] Correspondence

                Sharad Chandra, Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh–226003, India.

                Email: sharadaiims@ 123456gmail.com

                Author information
                https://orcid.org/0000-0002-1655-6965
                https://orcid.org/0000-0002-2706-8975
                Article
                CCR39036 CCR3-2023-12-2782.R2
                10.1002/ccr3.9036
                11245403
                39005572
                50050069-d1c2-4f78-8e42-f71e0f4fa9e1
                © 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 20 April 2024
                : 30 December 2023
                : 25 April 2024
                Page count
                Figures: 12, Tables: 0, Pages: 8, Words: 2800
                Categories
                Cardiology
                Case Report
                Case Report
                Custom metadata
                2.0
                July 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.4.5 mode:remove_FC converted:12.07.2024

                coronary artery aneurysm,left main coronary artery,stent,st‐segment elevation myocardial infarction

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