Recurrent ST-Elevation Myocardial Infarction (STEMI) in Coronary Artery Aneurysm Secondary to Atherosclerosis
Md Bhuiyan1, Faraz Badar2, Aqsa Ashraf3
1Internal Medicine, Northwell Health, Mather Hospital, Pleasant Valley, USA.
Insights
This case study highlights a rare coronary artery aneurysm (CAA) causing recurrent ST-elevation myocardial infarction (STEMI) even with dual antiplatelet therapy. Management involved advanced interventions and anticoagulation, preventing further events.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Coronary artery aneurysms (CAAs) are uncommon vascular abnormalities.
- Recurrent ST-elevation myocardial infarction (STEMI) in the presence of CAA poses significant management challenges.
- Standard dual antiplatelet therapy (DAPT) may be insufficient in preventing thrombotic events in complex CAA.
Abstract:
We describe a rare case of coronary artery aneurysm (CAA) with recurrent ST-elevation myocardial infarction (STEMI) despite being on standard dual antiplatelet therapy (DAPT). A 47-year-old male presented with chest pain and was found to have inferior wall STEMI along with diffuse right coronary artery (RCA) ectasia and proximal RCA aneurysm, thrombotic occlusion, and dissection. He was managed with extensive thrombectomy, angioplasty, prolonged Heparinization, and DAPT. The patient went on to have a similar presentation nine months later with a recurrent inferior wall STEMI with proximal RCA aneurysm and thrombotic occlusion managed with thrombectomy and bare metal stent placement. He was placed on long-term anticoagulation and DAPT with no further recurrence of MI reported on follow-up.
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