A rare case of ST-elevation myocardial infarction caused by thrombotic occlusion of a coronary artery aneurysm in the left anterior descending artery

Abstract

Background: Coronary artery aneurysm (CAA) is a rare condition in 0.3-4.9% of patients undergoing coronary angiography (CAG). Effort angina is the most common clinical manifestation in patients with CAA, along with dyspnea, arrhythmias, acute myocardial infarction (MI), congestive heart failure, cardiac arrest, or unstable angina. Its treatment options mainly include medical therapy, surgical resection, coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI).Case report: This case report summarizes our experience of treating MI caused by a thrombotic CAA. A 54-year-old woman presented with an acute ST-elevation myocardial infarction (STEMI) caused by thrombotic occlusion of a CAA in the left anterior descending (LAD) artery. She was treated withpercutaneous transluminal coronary angioplasty (PTCA) and was subsequently referred to our institution due to recurrence of chest pain and persistence of ST-wave changes. The patient’s clinical symptoms resolved after 10 days of anticoagulation (enoxaparin) and dual antiplatelet therapy (aspirin, clopidogrel). However, repeat CAG revealed recanalization and a fusiform aneurysm with thrombosis in the LAD. The patient was discharged in good physical condition with an indication for continuous anticoagulation (enoxaparin) and dual antiplatelet therapy (aspirin and clopidogrel).Conclusion: In the setting of acute MI, PTCA of an aneurysmal vessel followed by long-term anticoagulation may be associated with good clinical outcomes and could be considered a reasonable treatment choice. Additionally, intravascular ultrasound (IVUS) assessment remains extremely useful as a diagnostic tool and guide for treatment.