Performing intravascular procedures in highly inflammatory patients: think twice

Area of Science:

• Cardiology
• Vascular Medicine
• Hematology

Background:

• Intra-aortic thrombi with systemic embolization are rare but life-threatening.
• Risk factors include hypercoagulability and atherosclerosis.

Purpose of the Study:

• To present a case of intra-aortic thrombus formation and systemic thromboembolic events following coronary angiography in a patient with severe inflammation.
• To discuss the potential role of inflammation-induced arterial thrombosis and elevated coagulation factor VIII in this scenario.

Main Methods:

• Case report of a 46-year-old female with atypical pneumonia and elevated inflammatory markers.
• Diagnostic coronary angiography performed due to chest pain and troponin rise.
• Observation of systemic thromboembolic events occurring four days post-angiography.

Main Results:

• Coronary angiography revealed no significant stenosis, leading to a diagnosis of infectious perimyocarditis.
• A large intra-aortic thrombus was identified, causing multiple systemic thromboembolic events within 24 hours.
• The patient presented with highly elevated inflammatory parameters and suspected endothelial cell injury post-procedure.

Conclusions:

• The co-occurrence of aortic thrombi post-angiography in an inflamed patient suggests inflammation-induced arterial thrombosis.
• Endothelial cell injury during arterial procedures can amplify thrombus formation in hypercoagulable states.
• A cautious approach to invasive arterial procedures in highly inflamed patients is warranted, potentially guided by factor VIII levels.