Treatment of Intracoronary Thrombus Using Tirofiban in a Patient With Normal Coronary Arteries

Abstract

SUMMARYWe report a 64-year-old Turkish man who presented with unstable angina pectoris. Coronary angiography revealed massive intracoronary thrombus, which completely occluded the distal part of the left circumflex coronary artery. The thrombotic segment and the rest of the coronary tree were free of atherosclerosis. The patient was treated with intravenous tirofiban, a glycoprotein IIb/IIIa inhibitor. A control angiography was performed one week later and showed total dissolution of the thrombus with tirofiban therapy. ( The pathophysiological mechanism remains unclear. We report a case who had ICT in normal coronary arteries and was successfully treated with tirofiban. Case presentation: A 64-year-old man visited to our hospital with complaints of palpitations and chest pain-like angina. The patient said he fell down and remained unconscious for 3-5 minutes one week before coming to the hospital. Neurological and cardiac examinations were normal. Blood pressure and heart rate were 110/80 mmHg and 90 beats/minute respectively. Electrocardiography showed normal sinus rhythm and no ischemic changes. An electroencephalogram and 24-hour Holter monitoring were normal. Cardiac enzyme levels and other laboratory results were within normal ranges. The patient was diagnosed as having acute coronary syndrome (ACS) and a transient ischemic attack. He was given acetylsalicylic acid, a β-blocker, a statin (PO), nitroglycerin (IV), and lowmolecular weight heparin (SC).Coronary angiography performed two days later revealed a massive ICT, which completely occluded the distal part of the left circumflex coronary artery (Figure 1). A significant coronary artery spasm was also observed at the mid segFrom the Departments of

Successful treatment of saphenous venous graft thrombus by tirofiban infusion

“…11 There are a number of observations of spontaneous resolution of coronary thrombi in native coronary arteries with the use of anticoagulants and antiplatelet agents. [12][13][14] During his procedure, the patient was treated with aspirin, clopidogrel, and heparin. Thus, the available data indicate that aspirin is effective in improving vein-graft patency if commenced the day after surgery.…”

Intracoronary pharmacotherapy in the management of coronary microvascular dysfunction

“…There was an increase in the final TMPG 3 (54%) with eptifibatide [63]. The administration of IC tirofiban [750 lg (10 lg/kg)], a small molecule platelet IIb/IIIa inhibitor, has also been associated with resolution of intracoronary thrombus in the setting of an acute STEMI [64][65][66][67].…”