Acute intracoronary thrombosis in a normal coronary artery following coronary angiography: Thromboaspiration using a guide catheter

Abstract

A 60-year-old female presented with anterolateral non-ST elevation myocardial infarction and her coronary angiogram revealed severe left system coronary artery disease with a normal right coronary artery. Following coronary angiogram, she developed acute inferior wall and right ventricular ST elevation myocardial infarction with complete atrioventricular block and cardiogenic shock. Repeat coronary angiogram showed large proximal right coronary thrombus causing subtotal occlusion that was successfully aspirated using a guide catheter. The possible causes for intracoronary thrombosis following coronary angiography are discussed here.

Multiple coronary thrombosis

“…So the presence of thrombosis in the left main and right coronary arteries could have another story. Although very rare, in situ thrombosis formation in the catheter or on the guidewire and embolization to coronaries with injection 3 might be the cause of left main or RCA clots though not justifying all thromboses in this case. Careful examination of catheters and guidewires should have been done at the time.…”

ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation

“…Given her positive serology, it is reasonable to assume that at some point before her STEMI, she was infected with COVID-19; however, she was completely asymptomatic. Cardiac injury from COVID-19 is not well understood, however, the majority of cases reported involve patients with a severe form of the disease, usually requiring hospitalization [11][12][13][14][15][16][17]. COVID-19 is associated with hypercoagulability both during acute infection and after recovery 14 [11].…”

“…Cardiac injury from COVID-19 is not well understood, however, the majority of cases reported involve patients with a severe form of the disease, usually requiring hospitalization [11][12][13][14][15][16][17]. COVID-19 is associated with hypercoagulability both during acute infection and after recovery 14 [11]. Recent reports have shown arterial thrombosis in the heart, brain, and limbs in recovered patients that experienced only mild disease [15][16][17], however, coronary artery thrombosis in an asymptomatic COVID-19 carrier has never been reported.…”

“…Cases of AMI from severe coronary vasospasm have been reported with phentermine, a weight loss medication and an amphetamine derivative, but coronary artery thrombosis has not [3][4]. However, the literature review does show the possibility of coronary artery thrombosis secondary to endothelial damage from prolonged severe coronary vasospasm in patients without evidence of atherosclerotic plaque rupture [5][6][7][8][9][10][11]. More recently, coronavirus disease 2019 (COVID-19) has been shown to be associated with various thromboembolic phenomena, however, the majority of cases involving acute coronary artery occlusion have been observed in hospitalized patients with concurrent respiratory failure [12][13][14][15][16][17].…”

A right coronary artery saccular aneurysm leading to an embolic myocardial infarction during diagnostic cardiac catheterization: A case report

“…Although the rupture of minor plaques with or without spasm that can only be diagnosed using intravascular ultrasound (IVUS) may lead to thrombosis, it is also known that coronary aneurysms may contain invisible microthrombi that may induce further platelet aggregation, thrombosis, embolization, and subsequent myocardial infarction [11,12].…”