Coronary Artery Embolism and Myocardial Infarction, case report

Abstract

Coronary embolism (CE) is a rare cause of non-atherosclerotic acute coronary syndrome (ACS). The clinical presentation is similar to ACS, and the diagnosis is supported by Shibata criteria. Atrial fibrillation is the main reported etiology in CE cases. Management includes percutaneous intervention with thromboaspiration and anticoagulation. The following case is a description of a patient with acute chest pain and recently diagnosed atrial fibrillation (AF) with a rapid ventricular response, is described. A thrombotic lesion in the distal right coronary artery (RCA) of embolic origin, was documented. Successful mechanical thromboaspiration was performed; intravascular ultrasound (IVUS) showed no thrombus, dissection, or atherosclerotic plaque. CE is an underdiagnosed cause of ACS; diagnosis relies on Shibata criteria, and patients experience worse outcomes in follow-up.

Keywords: Acute Coronary Syndrome; Atrial Fibrillation; Embolism, Coronary Artery; Myocardial Infarction.

Figura 1. Initial Coronary Angiography. A) Left main coronary artery, left anterior descending artery, and left circumflex artery without significant stenotic lesions. B) Right coronary artery occluded in the distal segment.

Figura 2. A) Initial Coronary Angiography showing thrombotic occlusion in the right coronary artery. B) Balloon angioplasty with a semi-compliant balloon of 2.0 x 15 mm up to 14 atm. C) Mechanical thrombus aspiration obtaining abundant thrombus material. D) and E) Post-mechanical thrombus aspiration with improvement of distal flow. F) Intravascular ultrasound (IVUS) in the right coronary artery performed at 48 hours showing no evidence of atherosclerotic lesion, thrombus, or dissection.