Extensive coronary thrombus causing full thickness myocardial infarction.
A young male presented 22 h following onset of symptoms with an anterior ST-elevation myocardial infarction. He was transferred for rescue angioplasty after failing to reperfuse with thrombolytic therapy. On arrival, his symptoms had settled. Following administration of intracoronary abciximab and passage of an angioplasty wire into the distal LAD, extensive thrombus was demonstrated in the left anterior descending artery extending from the ostium to the distal vessel Figure 1(a). Further intervention with attempted thrombectomy was considered but it was postponed pending a viability study because of the risks of displacing thrombus down the circumflex. A cardiac MRI scan with delayed gadolinium hyper-enhancement demonstrated the classical appearance of full-thickness infarction in the LAD territory Figure 1(b). No further intervention was therefore indicated. At one-year follow-up, the patient remains free of angina with NYHA Class 1 symptoms of heart failure.
Curzen
Nicholas
N
Wessex Cardiac Unit, Southampton University Hospital, Southampton, UK. nick.curzen@suht.swest.nhs.uk
Hatrick
Robert
R
Peebles
Charles
C
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D015912:Thrombolytic Therapy
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab