Staged interventional management of a massive thrombus related to coronary artery ectasia in acute coronary syndrome
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CASE REPORT
Staged interventional management of a massive thrombus related to coronary artery ectasia in acute coronary syndrome Makoto Furugen • Yoshitoki Takagawa
Received: 3 July 2011 / Accepted: 27 September 2011 / Published online: 11 November 2011 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2011
Abstract Coronary artery ectasia (CAE), which is reported in 0.3–5.3% of coronary angiograms, is known as a risk factor of acute coronary syndrome (ACS). Optimal treatment of CAE in ACS has not yet been established because of few clinical reports and no randomized trial. We describe a 78-year-old woman in whom thrombolysis with recombinant tissue-plasminogen activator, heparin and dual antiplatelet therapy were performed, and an angiogram after 3 days revealed the disappearance of massive thrombus in the CAE of the left circumflex coronary artery. Staged percutaneous coronary intervention and multidisciplinary procedure are feasible to treat ACS with massive thrombus.
detected in 0.3–5.3% of consecutive angiographic studies and in 0.22–1.4% of autopsy series [1–3]. The presence of ectasic or aneurysmal segment produces sluggish or turbulent blood flow, with increased incidence of myocardial infarction. Aneurysmal dilation of an ischemia related artery (IRA) is associated with high-burden thrombus formation and a lower incidence of successful pharmacological or mechanical reperfusion. From these reasons, the presence of CAE in the IRA filled with high-burden thrombus represents a challenge case for interventional cardiologist. Here we report a case of an ACS with CAE of an IRA referred to our hospital for primary PCI and following staged procedures.
Keywords Acute coronary syndrome Coronary artery ectasia Massive thrombus Multidisciplinary procedure Case report Introduction Acute coronary syndrome (ACS) is caused by thrombus formation over a disrupted vulnerable plaque occluding an epicardial coronary artery. Coronary artery ectasia (CAE) can also cause ACS by a different pathophysiology from plaque rapture, since abnormal blood flow within the ectasia may lead to thrombus formation, occlusion or embolization in an epicardial coronary artery. CAE is M. Furugen (&) Department of Cardiology, Muroran City General Hospital, Yamate-Chou 3-8-1, Muroran 051-8512, Japan e-mail: [email protected] Y. Takagawa Department of Cardiology, Otaru Municipal Medical Center, Otaru, Japan
A 78-year-old woman presented to a community hospital with nausea and general malaise that had lasted since she had woken up. She had been treated for essential hypertension and dyslipidemia, and had had a stroke 29 years prior. She was transferred to our hospital for detailed examinations 8 h after she had woken up. She was afebrile and normotensive (blood pressure 132/70 mmHg) with a regular pulse of 60 beats/min. Results of cardiovascular, respiratory and abdominal examinations were within the normal range. A 12-lead electrocardiogram showed normal sinus rhythm, normal axis and inversional T wave in leads I, a
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