Recurrent Acute Myocardial Infarction in a Patient with Severe Coronary Artery Ectasia: Implication of Antithrombotic Therapy

Abstract

Patient: Female, 78Final Diagnosis: Acute myocardial infarctionSymptoms: Chest discomfortMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual clinical courseBackground:Acute myocardial infarction (AMI) can be caused not only by plaque rupture/erosion, but also by many other mechanisms. Thromboembolism due to atrial fibrillation and coronary thrombosis due to coronary artery ectasia are among the causes. Here we report on a case of recurrent myocardial infarction with coronary artery ectasia.Case Report:Our case was a 78-year-old woman with hypertension. Within a one-month interval, she developed AMI twice at the distal portion of her right coronary artery along with coronary artery ectasia. On both events, emergent coronary angiography showed no obvious organic stenosis or trace of plaque rupture at the culprit segment after thrombus aspiration. After the second acute event, we started anticoagulation therapy with warfarin to prevent thrombus formation. In the chronic phase, we confirmed, by using coronary angiography, optimal coherence tomography and intravascular ultrasound, that there was no plaque rupture and no obvious thrombus formation along the coronary artery ectasia segment of the distal right coronary artery, which suggested effectiveness of anticoagulant. Furthermore, by Doppler velocimetry we found sluggish blood flow only in the coronary artery ectasia lesion but not in the left atrium which is generally the main site of systemic thromboembolism revealed by transesophageal echocardiography.Conclusions:These results suggest that the two AMI events at the same coronary artery ectasia segment were caused by local thrombus formation due to local stagnant blood flow.Although it has not yet been generally established, anticoagulation therapy may be effective to prevent thrombus formation in patients with coronary artery ectasia regardless of the prevalence of atrial fibrillation.

Anti-inflammatory effects of rosuvastatin treatment in coronary artery ectasia patients in different age groups

“…CAE is considered a variation in atherosclerosis, mainly resulting from the thinning and/or destruction of the myocardial membrane. However, the dilatation process may be independent of the atherosclerotic process because it can be found as an isolated lesion in coronary arteries and other vascular systems [21]. Elevated in ammatory markers, such as plasma IL-6 and plasma soluble adhesion molecules, are closely linked to the presence of coronary artery dilation [22][23][24].…”

Is Anticoagulant Necessary in Patients with Coronary Artery Ectasia Presenting with Acute Coronary Syndrome? A Systematic Review of Case Reports

“…There was no prevalent stenotic lesion in three patients who experienced recurrence after DAPT therapy, which might indicate that anticoagulant was the most effective in CAE without other obvious stenotic lesions (isolated CAE) while DAPT was not. 9,11,14 This became more evident in a case by Damay et al who recorded four times ACS recurrence in which all of the stenotic lesion had been stented, before achieving 6 months' event free after optimal anticoagulation by warfarin. 17 Possible explanation for this finding is that stasis and slow-flow in the ectatic coronary artery is responsible for the clot formation rather than plaque rupture that usually occurs due to atherosclerotic vessels and role of anticoagulant is greater than antiplatelet in such condition.…”

“…We collected 13 cases from 11 reports. 1,2,[9][10][11][12][13][14][15][16] Ten patients (76.9%) were male, and three (23.1%) were female. Mean age was 54.92 AE 4.17 years.…”

Effects of rosuvastatin treatment on coronary artery ectasia in different patient age groups

“…CAE was considered a variation of atherosclerosis, mainly resulting from the thinning and/or destruction of the myocardial membrane. However, the dilatation process may be independent from the atherosclerotic process because it can be found as an isolated lesion in coronary arteries and other vascular systems [18]. It has been found that elevated inflammatory markers, such as plasma IL-6, and plasma soluble adhesion molecules are closely linked to the presence of coronary artery dilation [19][20][21].…”