Successful trapping of an organized thrombus in a coronary artery aneurysm in myocardial infarction: case report and literature review

Cardiovascular Revascularization Medicine : Including Molecular Interventions
Tobias HärleKarl-Heinz Kuck

Abstract

A 44-year-old female presented with acute inferior myocardial infarction. Emergency coronary angiography showed an aneurysm of the proximal right coronary artery and an occlusion of the vessel downstream due to a huge organized thrombus. Mechanical fragmentation, glycoprotein IIb/IIIa antagonist, and intracoronary thrombolysis were all tested without success. Finally, the aneurysm was covered with a standard bare metal stent in order to trap the thrombus between the stent and the vessel wall and at least partially in the aneurysm. The strategy was successful, and after 1 week, the blood flow in the right coronary artery was normal; however, the aneurysm remained. After 6 months, there was significant in-stent restenosis of the proximal and mid segments of the right coronary artery but no evidence of the aneurysm. The restenosis was treated with two drug-eluting stents, leading to an excellent result after a further 6 months. The patient was free of symptoms and the left ventricular ejection fraction was within the normal range.

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Citations

Aug 2, 2011·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Sion K RoyMatthew J Budoff
Jan 17, 2015·Texas Heart Institute Journal·Patricia D CrawleyDale C Wortham
Sep 22, 2017·Interventional Medicine & Applied Science·Ramesh GadepalliSai Nyayapathi Venkata Balakrishna
Mar 22, 2018·BMJ Case Reports·Alicia Blackman, Wayne Mohammed

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