Large Coronary Artery Aneurysm with Thrombotic Coronary Occlusion Resulting in ST-Elevation Myocardial Infarction after Warfarin Interruption.
10.12997/jla.2014.3.2.105
- Author:
Jun Hyoung KIM
1
;
Hyung Bok PARK
;
Young Bae LEE
;
Jae Hyuk LEE
;
Myung Sung KIM
;
Che Wan LIM
;
Deok Kyu CHO
Author Information
1. Department of Internal Medicine, Myongji Hospital, Goyang, Korea.
- Publication Type:Case Report
- Keywords:
Coronary aneurysm;
Thrombosis;
Myocardial infarction;
Thrombectomy
- MeSH:
Adult;
Aneurysm*;
Anticoagulants;
Aspirin;
Chest Pain;
Coronary Aneurysm;
Coronary Angiography;
Coronary Occlusion*;
Coronary Vessels*;
Drug Therapy;
Drug Therapy, Combination;
Emergency Service, Hospital;
Glycoproteins;
Humans;
Myocardial Infarction*;
Thrombectomy;
Thrombosis;
Warfarin*
- From:Journal of Lipid and Atherosclerosis
2014;3(2):105-109
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 44-year-old man, who had a history of myocardial infarction (MI) due to thrombotic occlusion of right coronary artery (RCA) aneurysm, visited emergency department presenting with ST-segment elevation myocardial infarction (STEMI). The patient had been on oral anticoagulant therapy (warfarin) from the first thrombotic event, but the medication had been recently changed to aspirin 4 months before the second event. Emergent coronary angiography revealed thrombotic total occlusion of RCA with heavy thrombotic burden from middle RCA to the ostium of the posterior descending branch. Combination pharmacotherapy was performed with anticoagulants (heparin), fibrinolytics (urokinase), and Glycoprotein IIb/IIIa antagonists (abciximab), in addition to mechanical thrombosuction. However, on hospital day 2, the patient complained recurrent chest pain and again underwent coronary angiography, which revealed distal embolization of large thrombus to the posterior lateral branch. Coronary flow was recovered after repeated mechanical thrombosuction was performed. This case has shown the importance of aggressive combination drug therapy, accompanied by mechanical thrombosuction in patient with myocardial infarction due to thrombotic occlusion of coronary artery aneurysm and the importance of unceasing life-long anticoagulant therapy in those particular patients.
