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Extensive right coronary artery thrombosis in a patient with COVID-19: A case report

Clarissa Campo Dall'Orto1, Rubens Pierry Ferreira Lopes2, Mariana Torres Cancela3

  • 1Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas 45987-088, Bahia, Brazil. clarissadallorto@alumni.usp.br.

World Journal of Clinical Cases
|November 17, 2022
PubMed

Insights

This case study details the first reported instance of right coronary artery thrombosis in a patient with coronavirus disease 2019 (COVID-19). Dual antiplatelet and anticoagulation therapy successfully resolved the extensive thrombi.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • Cardiovascular complications are frequent in hospitalized coronavirus disease 2019 (COVID-19) patients, contributing to significant morbidity and mortality.
  • Right coronary artery (RCA) thrombosis is a rare but serious complication associated with COVID-19.

Observation:

  • A 62-year-old female with COVID-19 presented with symptoms of myocardial infarction, including chest pain and ST-segment elevations.
  • Intracoronary imaging (intravascular ultrasound and optical coherence tomography) revealed extensive subacute and acute thrombi in the RCA and its branches, alongside underlying atherosclerosis.
  • Invasive physiological assessment using the resting full-cycle ratio showed no significant impairment in coronary flow despite the presence of plaque.

Findings:

  • This is the first documented case of extensive RCA thrombosis in a COVID-19 patient, comprehensively evaluated with intracoronary imaging and physiology.
  • Dual antiplatelet and anticoagulation therapy led to complete resolution of the coronary thrombi within 7 days.
  • The patient remained asymptomatic during a 6-month follow-up period.

Implications:

  • This case highlights the potential for severe thrombotic events in the coronary arteries of COVID-19 patients.
  • Effective management of COVID-19-associated coronary thrombosis can be achieved with timely dual antiplatelet and anticoagulation therapy.
  • Further research is warranted to understand the mechanisms and long-term cardiovascular impact of COVID-19 on coronary vasculature.
Abstract

Keywords:
Acute coronary syndromeCOVID-19, Intravascular ultrasoundCase reportCoronary angiographyThrombosis

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