Atherosclerosis is an inflammatory and degenerative disease of blood vessel.The common belief is (Of course , it is a fact ) it mainly causes vascular obstruction and compromise vital organ function(heart, Brain, Kidney etc)
Here is a different facet of atherosclerosis , A middle aged man surprised us with this coronary angiogram . Instead of obstructing the flow the coronary vessel begins to dilate. This is due to a medial weakness .(The media for some reason begins to give way rather than proliferate to the atherogenic stimuli.)
Same patient's RCA
One may wonder why he underwent CAG when obstruction is least expected in such a vessel ! It was paradox of sorts , this man in spite of his wide bore coronary artery , was prone for coronary thrombus and one such episode landed him in our CCU . ( Please note both faces of atherosclerosis “obstructive and dilatory” can manifest in the same vessel in different combination.)
This angiogram may be reported as any one of the following
- Diffuse atherosclerosis
- Diffuse atherosclerosis with focal dilatation and aneurysm formation
- Coronary ectasia
These patients should get life long medium intensity (INR 2-2.5) oral anti coagulants for preventing coronary thrombosis.
Watch out for similar aneurysmal changes elsewhere (Renal, Cerebral, Aorta etc )
Counter point
How are so sure it is is due to atherosclerosis ? Can it be a congenital coronary medial weakness ?
Your guess is not my guess . . . My vote is for atherosclerosis .
Dr.S.Venkatesan MD 
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