Prevalence of Coronary Artery Ectasia in Patients with Ascending Aortic Aneurysm: A Retrospective Observational Study

Aim:Coronary artery ectasia (CAE) is a rare coronary artery anomaly defined as dilation of a coronary artery segment to at least 1.5 times the diameter of the adjacent normal segment. Structural abnormalities of the vascular wall are thought to be associated with aortic aneurysms. This study, aimed to determine the prevalence of coronary artery ectasia in patients operated for ascending aortic aneurysm and to evaluate the relationship between aneurysm diameter and the presence of coronary ectasia and coronary flow characteristics.Methods:This retrospective observational study included patients who underwent surgery for ascending aortic aneurysm between 2015 and 2025 and who had preoperative coronary angiography. Demographic characteristics, cardiovascular risk factors, aneurysm diameter and angiographic findings were recorded. Coronary artery ectasia was defined as dilation exceeding 1.5 times the diameter of the adjacent normal segment and was classified according to the Markis classification. The coronary slow flow phenomenon was evaluated using the TIMI frame count method. Clinical and angiographic characteristics were compared according to the presence of ectasia and factors predicting ectasia were analyzed using logistic regression analysis.Results:A total of 115 patients were included in the study and coronary artery ectasia was detected in 36 patients (31.3%). The mean age of patients with ectasia was significantly higher than those without ectasia (63.6 ± 9.5 vs. 58.9 ± 10.8 years; p=0.026). An inverse relationship was found between ascending aortic diameter and the presence of coronary ectasia (p=0.048). In multivariate logistic regression analysis, age was shown to be an independent predictor of coronary ectasia. Coronary ectasia was most frequently detected in the right coronary artery, while Markis type I and type III were the most common ectasia types. In addition, the presence of coronary ectasia was observed to be associated with the coronary slow flow phenomenon.Conclusion:Coronary artery ectasia is observed more frequently in patients with ascending aortic aneurysm compared with the general coronary angiography population. Advanced age appears to be independently associated with the presence of coronary ectasia. In addition, the presence of coronary ectasia is associated with the coronary slow flow phenomenon, suggesting that coronary hemodynamic alterations may play a role in this patient population.