Coronary artery ectasia presenting with thrombus embolization and acute myocardial infarction a case report

Abstract

Rationale: Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. CAE is often associated with the presence of slow coronary flow and may lead to acute myocardial infarction (AMI), even without total occlusion. Patient concerns and diagnosis: We report a case of a 24-year-old male patient with CAE suffering from AMI. Interventions: Percutaneous coronary intervention with aspiration thrombectomy failed to restore adequate blood flow. Heparin and antiplatelet treatment were provided for pharmacological management, but follow-up angiography 15 days later still revealed a poor result. This patient was ultimately treated with antiplatelet therapy in combination with warfarin treatment. Outcomes: Follow-up coronary angiography 15 months later showed a restored normal Thrombolysis In Myocardial Infarction grade (TIMI) 3 flow. Lessons: CAE-related infarct is often associated with high-burden thrombus formation. Long-term warfarin in combination with antiplatelet therapy may be a good alternative intervention to decrease thrombus burden and enhance blood flow. Abbreviations: AMI = acute myocardial infarction, CAE = coronary artery ectasia, ECG = electrocardiogram, IVUS = intravascular ultrasound, LCX = left circumflex artery, LM = left main artery, OCT = optical coherence tomography, PCI = percutaneous coronary intervention, pPCI = primary percutaneous coronary intervention, TIMI = thrombolysis in myocardial infarction grade.