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Published on: February 28, 2012

[Coronary ectasia resulting in thrombotic coronary occlusion after warfarin interruption: a case report]

Shinya Fukuhara1, Eiji Takase, Takatomi Fujimoto

  • 1Division of Cardiology, Saiseikai-Suita Hospital, Osaka. shinyafukuhara@hotmail.com

Journal of Cardiology
|December 3, 2005
PubMed

Insights

A patient with an ectatic coronary artery experienced acute myocardial infarction after stopping warfarin. Successful reperfusion was achieved using a catheter to aspirate thrombus, highlighting the importance of anticoagulation.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Ectatic coronary artery disease (ECAD) presents unique challenges in managing acute coronary syndromes.
  • Patients on anticoagulation require careful monitoring, as discontinuation can increase thrombotic risk.

Observation:

  • A 68-year-old male with known ectatic right coronary artery presented with acute myocardial infarction.
  • The patient had recently discontinued warfarin due to bleeding complications, leading to a prothrombotic state.
  • Coronary angiography revealed complete occlusion with a large thrombus in the ectatic vessel.

Findings:

  • Standard aspiration thrombectomy was unsuccessful in restoring coronary blood flow.
  • A 5F straight catheter successfully aspirated the massive thrombus, achieving Thrombolysis in Myocardial Infarction grade 3 flow.
  • Intravascular ultrasonography identified "moyamoya" vessels, indicating abnormal coronary vasculature, but no unstable plaque.

Implications:

  • This case underscores the critical role of continuous anticoagulation (e.g., warfarin) in managing patients with ectatic coronary arteries to prevent thrombotic events.
  • Percutaneous coronary intervention strategies may need adaptation for the unique anatomy of ectatic coronary arteries.
  • Further research into optimal anticoagulation and revascularization strategies for ectatic coronary artery disease is warranted.

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