Large Nonobstructive Coronary Thrombus in a Patient With Acute Coronary Syndrome: Can it Be Treated Conservatively?

We report the case of a young patient who presented with acute coronary syndrome and a large thrombus in the left anterior descending coronary artery. Because he had no symptoms of ongoing ischemia in the catheterization laboratory and had TIMI flow grade 3 distally to the thrombus, he was initially treated conservatively with intense antithrombotic therapy. On repeat angiography, approximately 2 days later, the thrombus was still apparent; but after continuing the antithrombotic regimen for 7 days in total, the third coronary angiography showed that the thrombus had been resolved. Optical coherence tomography showed no plaque rupture obviating the need for angioplasty.