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

Cardiovasc Revasc Med. 2008 Jan-Mar;9(1):52-5. doi: 10.1016/j.carrev.2007.08.006.

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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / instrumentation*
  • Coronary Angiography
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / therapy*
  • Coronary Restenosis / etiology
  • Coronary Restenosis / therapy
  • Coronary Thrombosis / diagnostic imaging
  • Coronary Thrombosis / etiology
  • Coronary Thrombosis / therapy*
  • Drug-Eluting Stents
  • Embolism / diagnostic imaging
  • Embolism / etiology
  • Embolism / therapy*
  • Female
  • Humans
  • Metals
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / etiology
  • Myocardial Infarction / therapy*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Prosthesis Design
  • Stents*
  • Thrombectomy
  • Thrombolytic Therapy
  • Treatment Outcome
  • Vascular Fistula / complications
  • Vascular Fistula / diagnostic imaging
  • Vascular Fistula / therapy*

Substances

  • Metals
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex