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Case Reports
. 2017 Jan;96(4):e5976.
doi: 10.1097/MD.0000000000005976.

Coronary artery ectasia presenting with thrombus embolization and acute myocardial infarction: A case report

Yongle Li  1 , Chengcheng Wu, Wennan Liu
Affiliations
Case Reports

Coronary artery ectasia presenting with thrombus embolization and acute myocardial infarction: A case report

Yongle Li et al. Medicine (Baltimore). 2017 Jan.

Abstract

Rationale: Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. CAE is often associated with the presence of slow coronary flow and may lead to acute myocardial infarction (AMI), even without total occlusion.

Patient concerns and diagnosis: We report a case of a 24-year-old male patient with CAE suffering from AMI.

Interventions: Percutaneous coronary intervention with aspiration thrombectomy failed to restore adequate blood flow. Heparin and antiplatelet treatment were provided for pharmacological management, but follow-up angiography 15 days later still revealed a poor result. This patient was ultimately treated with antiplatelet therapy in combination with warfarin treatment.

Outcomes: Follow-up coronary angiography 15 months later showed a restored normal Thrombolysis In Myocardial Infarction grade (TIMI) 3 flow.

Lessons: CAE-related infarct is often associated with high-burden thrombus formation. Long-term warfarin in combination with antiplatelet therapy may be a good alternative intervention to decrease thrombus burden and enhance blood flow.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Coronary angiography images before thrombus aspirations. A–C, Ectasia of LM, and ectasia and total thrombotic occlusion of the distal LCX. The left anterior descending artery was normal. D, The right coronary artery was normal. LCX = left circumflex artery, LM = left main artery.
Figure 2
Figure 2
Angiographic images of the LCX, postthrombus aspirations in (A) right caudal view and (B) antero-posterior caudal view. After several attempted thrombus aspirations, only TIMI 2 flow was restored in the second obtuse marginal branch. The second coronary angiography images of the LCX 15 days after admission in (C) right caudal view and (D) antero-posterior caudal view. There was still an obstructive filling defect in the distal portion of the LCX. TIMI 3 flow was restored in the second obtuse marginal branch. The third coronary angiography images of the LCX 15 months after discharge in (E) right caudal view and (F) antero-posterior caudal view. TIMI 3 flow was restored in the LCX and almost complete resolution of the thrombus was noted. LCX = left circumflex artery, TIMI = thrombolysis in myocardial infarction grade.
Figure 3
Figure 3
Sixty-four-slice coronary computed tomographic angiography images of the LCX 10 days after admission. A and B, Three-dimensional computed tomography reconstruction showing coronary artery ectasia involving the LM and LCX. C and D, A filling defect is shown in the distal portion of the LCX (arrow). LCX = left circumflex artery, LM = left main artery.
See this image and copyright information in PMC

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