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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 - Korean Circ J (2010)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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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Figure 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.

Mentions: After 3 days of intravenous unfractionated heparin (25,000 IU/day), follow-up CAG showed only slight resolution of the filling defect and only in the dLAD, not in the OM and dLCX (Fig. 3A and B). He had no chest pain and was discharged on triple antiplatelet agent. After 1 year of this treatment, he experienced no chest pain and, on follow up CAG, had no significant stenosis or intracoronary filling defects (Fig. 3C and D).


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 - Korean Circ J (2010)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2812798&req=5

Figure 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.
Mentions: After 3 days of intravenous unfractionated heparin (25,000 IU/day), follow-up CAG showed only slight resolution of the filling defect and only in the dLAD, not in the OM and dLCX (Fig. 3A and B). He had no chest pain and was discharged on triple antiplatelet agent. After 1 year of this treatment, he experienced no chest pain and, on follow up CAG, had no significant stenosis or intracoronary filling defects (Fig. 3C and D).

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Daegu Catholic University Medical Center, Daegu, Korea.

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.

No MeSH data available.


Related in: MedlinePlus