The role of coronary thrombosis in myocardial infarction: Further evidence shown by intracoronary thrombolysis with streptokinase

Abstract

Myocardial infarction is usually caused by a thrombus occurring on a significant coronary lesion. A 60-year-old male was admitted with an acute evolving anterior myocardial infarction. Three hours after the beginning of chest pain, the electrocardiogram showed ST-segment elevation in the anterior and lateral leads which persisted despite intravenous nitroglycerin (100 mcg/min). One hour later, an angiogram showed complete obstruction at the origin of the left anterior descending artery (LAD). After intracoronary streptokinase (250,000 units) the LAD opened and a 90% obstruction was seen at its origin. However, an anterior myocardial infarction occurred. One month later, an angiogram showed a slight irregularity at the origin of the LAD. Thus, this case demonstrates that 1) a myocardial infarction may occur with a near normal coronary artery, and 2) a thrombus may occur at the site of a slight coronary irregularity.

A case of normal coronary infarction after intracoronary thrombolysis with urokinase

“…Gagnon et al [9] reported a case of intracoronary thrombolysis without significant narrowing in the chronic stage and suggested that an occlusive thrombus, arising on the very mild atheromatous change, was completely resolved in the hospital course. Although the case herein reported is somewhat like that of Gagnon et al, the resolving thrombus was directly shown in the angiogram in the acute stage (Fig.…”