Korean J Crit Care Med.  2015 Nov;30(4):358-364. 10.4266/kjccm.2015.30.4.358.

ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis

• Roh JW
• Park EH
• Song JC
• Oh YS
• Kim TY
• Kim HS
• Lim S

• KMID: 2156195
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.358

Abstract

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

Keyword

antiplatelet agents; coronary artery ectasia; liver cirrhosis; ST-segment elevation myocardial infarction

MeSH Terms

Angioplasty, Balloon
Aspirin
Coronary Vessels*
Dilatation
Dilatation, Pathologic
Humans
Liver Cirrhosis*
Liver*
Myocardial Infarction*
Platelet Aggregation Inhibitors
Prognosis
Stents
Thrombosis*
Aspirin
Platelet Aggregation Inhibitors

Figure

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  Fig. 1. Electrocardiograms at admission shows ST-segment elevation on the ll, lll, and aVF leads with reciprocal change on the I and aVL leads.

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  Fig. 2. Coronary angiography shows severe ectatic dilatation in all 3 mojor epicardial coronary arteries. (A) Distal right coronary artery was totally occluded by thrombus. Proximal right coronary artery segment diameter is 7.9 mm, (B) proximal left anterior descending coronary artery segment diameter is 7.0 mm and the proximal left circumflex coronary artery is 7.6 mm. RCA: right coronary artery; LAD: left anterior descending coronary artery; LCX: left circumflex coronary artery.

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  Fig. 3. There are aspirated red thrombi by thrombosuction device.

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  Fig. 4. After thrombosuction, right coronary artery flow was totally recovered.

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  Fig. 5. Electrocardiogram one day after thrombosuction shows ST-segment resolution on II, III, and aVF leads.

Reference

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