Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow

Authors

Alejandro Herrera, Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Odessa, Texas, USA.
Carlos Felipe Matute Martinez, Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Odessa, Texas, USA carlosfmatute@gmail.com.
Juan Fernando Toledo Martinez, Universidad Católica de Honduras Nuestra Señora Reina de la Paz, Facultad de medicina y cirugia, San Pedro Sula, Honduras.
Allan Beall, Advocate Aurora HealthFollow

Recommended Citation

Herrera A, Matute Martinez CF, Toledo Martinez JF, Beall A. Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow. BMJ Case Rep. 2021;14(11):e245219. Published 2021 Nov 30. doi:10.1136/bcr-2021-245219

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

A coronary artery aneurysm (CAA) is an uncommon clinical finding with an incidence of <5% in adults. The presence of a large intracoronary thrombus within an aneurysmal coronary artery and normal coronary flow is usually a very challenging case scenario. Here, we present a case of a patient presenting with typical chest pain symptoms, high-risk findings on a pharmacological nuclear stress test and coronary angiogram showing severe multivessel coronary artery disease, including a large aneurysmal segment within the proximal left anterior descending artery with a large thrombus that did not affect intracoronary flow. Today, there are no published guidelines for the management of CAA with a normal intracoronary flow. The approach used in this case was initial antithrombotic therapy followed by a successful staged percutaneous coronary intervention. Here, we present a case supporting the use of combined intravenous anticoagulant and antiplatelet therapy for 48 hours, followed by successful percutaneous intervention guided by intravascular ultrasound.

Document Type

Article

PubMed ID

34848409