Successful trapping of an organized thrombus in a coronary artery aneurysm in myocardial infarction: case report and literature review.
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.
Härle
Tobias
T
Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. t.haerle@gmx.de
Reimers
Jacobus
J
Hertting
Klaus
K
Kuck
Karl-Heinz
KH
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D054855:Drug-Eluting Stents; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011474:Prosthesis Design; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
D008670:Metals; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex