title: Intravascular ultrasound and angiographic demonstration of left main stem thrombus-high-risk presentation in a young adult with anabolic steroid abuse.
abstract: We present a case of acute myocardial infarction in a young adult with a history of anabolic steroid abuse. On diagnostic coronary angiography and intravascular ultrasound, he was found to have a distal left main stem thrombus extending into the proximal left anterior descending artery and a large intermediate vessel. As he was hemodynamically stable and pain-free, he was managed conservatively with triple antiplatelet therapy (aspirin, clopidogrel, and abciximab). This was also to avoid the risk of 'wiring the vessel,' especially if there was underlying dissection. Repeat angiography a few weeks later showed complete thrombus resolution. This is the first reported case of extensive left main stem thrombus in a young patient with anabolic steroid abuse. Management of such cases is not straightforward and our case highlights one approach to both diagnosis and treatment.
authors.affiliation: Aintree Cardiac Centre, University Hospital Aintree, Liverpool, UK. pankajvic@gmail.com
authors.forename: Pankaj
authors.initials: P
authors.lastname: Garg
authors.forename: Gershan
authors.initials: G
authors.lastname: Davis
authors.forename: John Ian
authors.initials: JI
authors.lastname: Wilson
authors.forename: Mohan
authors.initials: M
authors.lastname: Sivananthan
mesh_terms: D000077284:Abciximab; D045930:Anabolic Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000150:complications*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab