A case of acute myocardial infarction caused by distal embolization of a left main coronary artery thrombus.
Coronary embolism is an uncommon cause of myocardial infarction. A 48-year-old male presented with typical chest pain of an MI. There was no definite ST segment change on electrocardiogram (ECG) and no elevation of myocardial enzymes. Coronary angiography (CAG) revealed occlusion of the distal left anterior descending coronary artery (dLAD), the distal left circumflex coronary artery (dLCX), the diagonal branch (D) and the obtuse marginal branch (OM), with a large filling defect in the left main coronary artery (LMA) that caused the myocardial infarction. We considered the possibility that coronary embolization was caused by the migration of a thrombus in the LMA during CAG. We did balloon angioplasty in the dLAD, dLCX, OM and D and treated the patient with glycoprotein IIb/IIIa receptor antagonist. However, thrombi remained in the dLAD, OM, and dLCX. After 3 days of anti-thrombotic treatment, follow-up CAG revealed only slight resolution of thrombi in the LAD. After triple antiplatelet agent medication for 1 year, a follow-up CAG showed a resolution of the thrombi in all coronary arteries.
Bae
Kyung-Ryun
KR
Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea.
Lee
Young-Soo
YS
Kim
Byong-Kyu
BK
Ha
Geun-Jin
GJ
Kim
So-Yeon
SY
Choi
Ji-Young
JY
Kim
Kee-Sik
KS