Coronary Artery Ectasia - The Need for an Expanded Classification.

Arun Gopalakrishnan, Sanjay Ganapathi, Krishna Kumar Mohanan Nair, Harikrishnan Sivadasanpillai, Ajitkumar Valaparambil Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala Sir, W read with interest the article by Kerr et al on coronary artery ectasia and congratulate the authors for their work.1 We would like to share a few perspectives on the related entity of coronary aneurysms, and on the limitations of the classification used by the authors. While coronary aneurysms and ectasia are possibly differing manifestations of the same pathophysiological process, isolated coronary artery ectasia is rare. The higher prevalence of coronary artery ectasia in the index study is not unexpected as i t was a single center study which primarily included patients who presented with coronary events. Coronary aneurysms are of two types, saccular and fusiform. Saccular aneurysm re fers to an aneurysm with the transverse dimension of the involved segment greater than longitudinal dimension (along the axis of the vessel) while fusiform aneurysm is an aneurysm with the longitudinal dimension at least twice its transverse dimension.2 It would be relevant to mention our experience in an earlier study where we had tried to classify our cases of coronary artery ectasia based on the proposed classification by Markis. We had noted that not all patients could be classified into one of the four groups, like those with diffuse ectasia in one vessel, localized ectasia in two vessels or localized ectasia in two or three vessels.2 This formed the basis of the revised classification which is given below for reference (Table 1). Localized ectasia was defined as ectasia involving less than 50% of the length of the vessel. This modification facilitates easy classification of all different types of ectasia unlike the original classification by Markis et al.2,3