背景:冠状动脉动脉瘤(CAA),动静脉畸形(CAVMs),和自发性夹层(SCAD)是罕见的临床实体,很多关于它们的自然史是未知的,预后和管理。
方法:对MEDLINE的系统搜索,Embase和Cochrane图书馆数据库于2023年3月进行,以确定与CAA相关的已发表论文,CAVM和SCAD。
结果:在接受血管造影术的患者中有0.3-12%的CAAs,并且通常与冠状动脉粥样硬化有关。它们通常无症状,但可在高达4.8%的患者中并发血栓形成,很少发生破裂(0.2%)。CAA可以通过医学管理,经皮使用支架或线圈栓塞,和手术。最常见的外科手术是结扎动脉瘤,然后进行冠状动脉旁路移植术(CABG)。在接受血管造影的患者中,CAVM的发生率为0.1-0.2%,它们很可能与冠状血管的先天性异常发育有关。CAVM的诊断通常是偶然的。手术或经皮介入治疗适用于大型CAVM患者,有心肌梗塞的潜在风险。SCAD占所有急性冠状动脉综合征的1-4%,通常会影响年轻女性。SCAD与妊娠密切相关,表明性激素在其发病机理中的作用。SCAD的保守管理对于没有缺血迹象的稳定患者是优选的,因为经常报道自发消退。不稳定的患者应进行经皮或CABG的血运重建。
结论:需要关于这些罕见疾病的管理的进一步证据,并且可以理想地从多中心合作中获得。
BACKGROUND: Coronary artery aneurysms (CAAs), coronary arteriovenous malformations (CAVMs), and spontaneous coronary artery dissections (SCADs) are rare clinical entities, and much is unknown about their natural history, prognosis, and management.
METHODS: A systematic search of MEDLINE, Embase, and Cochrane Library databases was performed in March 2023 to identify published papers related to CAAs, CAVMs, and SCADs.
RESULTS: CAAs are found in 0.3% to 12% of patients undergoing angiography and are often associated with coronary atherosclerosis. They are usually asymptomatic but can be complicated by thrombosis in up to 4.8% of patients and rarely by rupture (0.2%). CAAs can be managed medically, percutaneously with stents or coil embolization, and surgically. The most common surgical procedure is ligation of the aneurysm, followed by coronary artery bypass grafting. The incidence of CAVMs is 0.1% to 0.2% in patients undergoing angiography, and they are most likely associated with congenital abnormal development of the coronary vessels. The diagnosis of CAVMs is usually incidental. Surgical or percutaneous intervention is indicated for patients with large CAVMs, which carry a potential risk of myocardial infarction. SCADs represent 1% to 4% of all acute coronary syndromes and typically affect young women. SCADs are strongly correlated with pregnancy, suggesting the role of sex hormones in their pathogenesis. Conservative management of SCAD is preferred for stable patients without signs of ischemia as spontaneous resolution is frequently reported. Unstable patients should undergo revascularization either percutaneously or with coronary artery bypass grafting.
CONCLUSIONS: Further evidence regarding the management of these rare diseases is needed and can ideally be derived from multicenter collaborations.