Statistics from Altmetric.com
A 55 year old male patient without previous cardiac history underwent coronary angiography because of angina pectoris (Canadian Cardiovascular Society class 3) and a positive exercise test. The right coronary artery and left anterior descending artery showed only mild irregularities, but the mid right circumflex (RCX) artery showed a luminal filling defect suggestive of thrombus just proximal to a severe stenosis (panel A). Left ventricular function was normal. The procedure was ended and it was decided to perform percutaneous coronary intervention of the RCX after 24 hours of pre-treatment with a glycoprotein IIb/IIIa inhibitor. However, only minutes after completion of the procedure the patient complained of severe chest pain. Repeat angiography showed an occluded RCX (panel B). It was noted that a sidebranch to the left atrium was now visible whereas it was not on the previous film, suggesting embolisation of a previously occluding thrombus. Immediate angioplasty of the RCX was performed, resulting in distal embolisation and no reflow (panel C), without any improvement after intracoronary papaverine. Subsequently, a thrombectomy device (Rescue catheter, Boston Scientific) was used in an attempt to remove thrombotic material and improve coronary flow. A red, organised thrombus (6 × 2 mm) was removed (lower panel). The final result of the procedure showed TIMI 3 flow and grade 3 myocardial blush (panel D). Maximum creatine kinase-MB was 29 μg/l, and left ventricular ejection fraction was 68% after two months.
This case illustrates one of the less frequent mechanisms of acute myocardial infarction—namely, embolisation of a coronary thrombus. Thrombus formation may have occurred due to turbulent flow just proximal to a severe stenosis.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.