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Coronary Artery Ectasia with Acute Myocardial Infarction, A Case Report
Maysan M Almegbel1, Fawaz Q Almutairi2
1King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi Arabia.
Insights
Coronary artery ectasia (CAE) can present as ST-elevation myocardial infarction (STEMI). This case demonstrates successful treatment of a clot burden in ectatic coronary arteries using angioplasty and stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary artery ectasia (CAE), or aneurysmal coronary artery disease, involves abnormal dilatation of coronary arteries, affecting 1.2-4.9% of patients.
- While often asymptomatic, CAE can present with acute coronary syndromes like ST-elevation myocardial infarction (STEMI).
- Standardized treatments for CAE itself are lacking, with management typically mirroring that of obstructive coronary artery disease.
Observation:
- A 46-year-old male with no prior medical history presented with inferior STEMI.
- Coronary angiography revealed multiple ectatic segments in the right coronary artery (RCA) with a 100% stenosis and significant clot burden.
- The patient was treated with an aggrastat infusion followed by repeat angiography.
Findings:
- The repeat angiography showed complete clot resolution.
- The affected RCA segment was successfully stented with a drug-eluting stent, achieving an excellent outcome.
- This case highlights a unique presentation of CAE associated with STEMI and its safe management in the cath lab.
Implications:
- CAE, though uncommon, should be considered in patients presenting with STEMI, especially when angiography reveals unusual vessel morphology.
- Percutaneous coronary intervention, including stenting, can be a safe and effective treatment for acute occlusive events in the setting of CAE.
- Further research into the specific pathophysiology and optimal management strategies for CAE presenting with acute coronary syndromes is warranted.
Abstract:
Coronary artery ectasia (CAE), also known as aneurysmal coronary artery disease, is defined as an abnormal diffuse (ectasia) or segmental (aneurysmal) dilatation of any branch of the coronary arteries. It is a well-recognized entity with 1.2-4.9% prevalence. Our case is a 46 year old male with no prior medical problem who presented to the ER with inferior ST elevation myocardial infarction (STEMI). The Coronary angiogram revealed multiple ectatic segments in the right coronary artery (RCA) with 100% stenosis in the middle segment. Upon wiring the RCA a big clot burden was noted on the ectatic segment. We planned to keep him on aggrastat infusion for 24 hours then re-cath him. The second cath showed complete resolution of the clot and the lesion was stented with drug eluting stent showing excellent final result. We found that our case is interesting and unique in exploring the association of CAE that presents with STEMI and how to treat it safely in the cath lab, knowing that CAE is an uncommon finding during coronary angiography. CAE is associated with many coronary artery disease (CAD) risk factors and etiologies as well as pathologic progression. Patients with CAE are usually asymptomatic but can still present with symptoms of coronary artery occlusion. There is still no standard treatment specific for CAE itself, but when presenting with occlusive symptoms, management is guided by the extent of occlusion similar to CAD.
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