Aneurysmal Coronary Artery Disease: A Contemporary and Comprehensive Review

Abstract Coronary artery aneurysm (CAA) is a focal enlargement of the coronary artery exceeding 1.5 times the diameter of the adjacent normal segment of the vessel. The reported prevalence of CAA varies widely from 0.2 to 10%, with male predominance and a predilection for the right coronary artery. Atherosclerosis is the main cause in adults and Kawasaki disease in children. While often asymptomatic, CAA may present with angina, myocardial infarction, or possible fatal complications such as rupture, compression of adjacent cardiopulmonary structures, thrombus formation, and distal embolization. CAA is usually an incidental finding during coronary angiography; however, advancements in cardiac imaging have enhanced the detection and characterization of CAA. Coronary computed tomography angiography and magnetic resonance angiography offer alternatives to traditional approaches with high-resolution images that can help with risk stratification and management planning. Management varies based on the size, location, complications, and presence of symptoms. It includes medical therapy, percutaneous intervention, and surgical approach. In this paper, we aim to provide a comprehensive review of current knowledge of CAA and recent advances in its diagnosis and management.