Usefulness of multimodality cardiac imaging in a patient with ST elevation myocardial infarction caused by two giant coronary artery aneurysms

Abstract

Coronary artery aneurysm (CAA) is a rare cause of myocardial infarction. However, only a few studies have investigated this aspect. An 84-year-old woman with a history of hypertension presented with nausea. showed ST elevation in the inferior leads, and coronary angiography revealed two giant CAAs in the right coronary artery. Percutaneous coronary intervention was difficult because of risk of CAA rupture. Thus, these aneurysms were further evaluated using multimodality cardiac imaging to determine the treatment. MRI using late gadolinium enhancement revealed structural features of the aneurysms and the viability of the myocardium. Only antithrombotic medication was administered on the basis of the results of the multimodality cardiac imaging. Here, we report a rare case of a patient diagnosed with ST elevation myocardial infarction caused by thrombosis in giant CAAs using multimodality cardiac imaging, particularly MRI.

“Floating” Stent in a Coronary Aneurysm Presenting as ST-Elevation Myocardial Infarction

“…Some algorithms have been published [ 10 ], which include the use of intracoronary imaging, specifically IVUS. The intracoronary images of the coronary arteries provide information on the composition of the lumen and the arterial wall [ 11 ]. The application of these techniques is probably one of the greatest advances in this field in recent years.…”

Giant Coronary Aneurysm Causing Ostial Occlusion of Coronary Artery by Mass Effect: A Case Report

“…The clinical presentation of GCA may range from asymptomatic to life-threatening complications. Although rare, an aneurysm could undergo thrombotic changes and may lead to AMI, but the exact incidence of AMI in GCA remains unknown [ 8 ]. Forte et al, in a study from Italy, have reported that 66.7% of CAA developed intraluminal thrombosis, out of which only 22.3% presented with atypical chest pain [ 9 ].…”

“…Although selective invasive coronary angiogram remains the gold standard to diagnose GCA, an initial noninvasive test may provide a clue to its diagnosis by the detection of mass-like appearance on chest X-ray and echocardiogram. Moreover, the major limitation of ICA is the failure to detect aneurysms in the presence of intraluminal thrombi and its relationship to the surrounding structures, as it is a luminogram only [ 8 ]. In our case, thrombosis of RCA aneurysm led to compression of the proximal segment of RCA due to mass effect causing AMI.…”