Coronary Artery Ectasia Presenting as ST-Elevation Myocardial Infarction: An Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Strategy and Case-Based Review

Coronary artery ectasia (CAE) is characterized by abnormal, localized, or diffuse dilatation of the coronary vasculature and is an increasingly recognized anatomical entity encountered during coronary angiography. Although often associated with atherosclerosis, the exact pathogenesis of CAE remains unknown; hence, an optimal management strategy is difficult to establish and remains highly controversial due to a lack of high-quality randomized controlled trial evidence. Current therapeutic modalities include medical therapy, percutaneous coronary intervention (PCI), and surgical options. We present a review, supported by a representative case of ST-elevation myocardial infarction (STEMI) in a patient with CAE, as a systematic summary of the clinical and angiographic features of the condition. We discuss contemporary treatment approaches, especially how to navigate antithrombotic strategies and the role of intravascular ultrasound (IVUS)-guided PCI.