Etiology of Coronary Artery Disease Usually, coronary artery disease is due to Coronary artery atherosclerosis: Subintimal deposition of atheromas in large and medium-sized coronary arteries Less often, coronary artery disease is due to Coronary artery spasm (see Variant Angina) Vascular endothelial dysfunction can promote atherosclerosis and contribute to coronary artery spasm.