Korean Circ J.  2010 Jan;40(1):46-49. 10.4070/kcj.2010.40.1.46.

A Case of Acute Myocardial Infarction Caused by Distal Embolization of a Left Main Coronary Artery Thrombus

• Bae KR
• Lee YS
• Kim BK
• Ha GJ
• Kim SY
• Choi JY
• Kim KS

• KMID: 1776306
• DOI: http://doi.org/10.4070/kcj.2010.40.1.46

Abstract

Coronary embolism is an uncommon cause of myocardial infarction. A 48-year-old male presented with typical chest pain of an MI. There was no definite ST segment change on electrocardiogram (ECG) and no elevation of myocardial enzymes. Coronary angiography (CAG) revealed occlusion of the distal left anterior descending coronary artery (dLAD), the distal left circumflex coronary artery (dLCX), the diagonal branch (D) and the obtuse marginal branch (OM), with a large filling defect in the left main coronary artery (LMA) that caused the myocardial infarction. We considered the possibility that coronary embolization was caused by the migration of a thrombus in the LMA during CAG. We did balloon angioplasty in the dLAD, dLCX, OM and D and treated the patient with glycoprotein IIb/IIIa receptor antagonist. However, thrombi remained in the dLAD, OM, and dLCX. After 3 days of anti-thrombotic treatment, follow-up CAG revealed only slight resolution of thrombi in the LAD. After triple antiplatelet agent medication for 1 year, a follow-up CAG showed a resolution of the thrombi in all coronary arteries.

Keyword

Embolism; Myocardial infarction

MeSH Terms

Angioplasty, Balloon
Chest Pain
Coronary Angiography
Coronary Vessels
Electrocardiography
Embolism
Follow-Up Studies
Glycoproteins
Humans
Male
Middle Aged
Myocardial Infarction
Thrombosis
Glycoproteins

Figure

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  Fig. 1 ECG changes A: the initial ECG during typical chest pain shows no definite ST segment change. B: the follow-up ECG after coronary embolization shows ST segment elevation at lead II, III, aVF and V3-6. ECG: electrocardiogram. ECG changes.

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  Fig. 2 The distal embolization at coronary artery. A and B: the diagnostic coronary angiogram (CAG) shows large thrombus at left main coronary artery (LMA) (arrow head) and filling defects at distal portion of left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) (arrow). C: after engagement of guiding catheter, there are new filling defects at the obtuse marginal branch (OM) and 1st diagonal branch (D1) and larger filling defect at LCX. D: the intravascular ultrasound reveals the large thrombus at LMA (*). E and F: even though the aspiration of thrombus at LM and multiple balloonings at LAD, LCX, D1 and OM, the most of thrombi (arrow) remain except D1. A: antero-posterior cranial view, B, C and F: right anterior oblique caudal views, D: right anterior oblique cranial view.

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  Fig. 3 Coronary angiography finding. A and B: after administration of glycoprotein IIb/IIIa receptor antagonist and intravenous unfractionated heparin for 3 days, the follow-up coronary angiography (CAG) shows slightly resolved thrombus at distal portion of the left anterior descending coronary artery (LAD) but the thrombi (arrow) at left circumflex coronary artery (LCX) and obtuse marginal branch (OM) remain. C and D: after triple antiplatelet agents for 1 year, the follow-up CAG shows no thrombus at all coronary arteries. A and C: right anterior oblique caudal views, B and D: right anterior oblique cranial views.

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