Case report of penetrating coronary artery ulcer of the right coronary artery in a middle-aged man presenting with
Olurotimi J Badero1, Bamikole T Osibowale2, Pelumi V Ajayi3
1Division of Cardio Nephrology, Cardiac Renal & Renal Vascular Associates, Jackson, MS, USA.
Insights
Penetrating coronary artery ulcers (PCAU) are rare but serious vascular conditions. Early recognition and individualized management are crucial for preventing adverse cardiovascular events, though specific guidelines are lacking.
Area of Science:
- Cardiology
- Vascular Medicine
- Interventional Cardiology
Background:
- Penetrating coronary artery ulcers (PCAU) are rare disruptions of the coronary artery wall, often stemming from plaque rupture.
- PCAU presentation can mimic other acute coronary syndromes, complicating diagnosis and management.
- Limited understanding and lack of established guidelines hinder effective treatment strategies for PCAU.
Purpose of the Study:
- To highlight the clinical presentation and management of a rare case of penetrating coronary artery ulcer.
- To emphasize the importance of early recognition and individualized treatment for PCAU.
- To contribute to the limited evidence base for managing penetrating coronary artery ulcers.
Main Methods:
- Case report of a 64-year-old male with recurrent chest pain and complex cardiac history.
- Diagnostic cardiac catheterization to identify the penetrating coronary artery ulcer.
- Conservative management approach for the identified proximal right coronary artery ulcer.
Main Results:
- Cardiac catheterization revealed a grade II penetrating ulcer in the proximal right coronary artery without obstructive lesions.
- The patient was managed conservatively with a positive clinical outcome.
- This case underscores the diagnostic challenges and varied management possibilities for PCAU.
Conclusions:
- Penetrating coronary artery ulcers are rare and lack specific treatment guidelines.
- Early diagnosis using multimodality imaging and tailored management are vital for preventing complications like dissection or thrombosis.
- Further research and reporting of PCAU cases are essential for developing evidence-based guidelines.
Background:
Penetrating Coronary artery ulcers (PCAU) are rarely reported disruption of vascular wall integrity believed to arise from plaque rupture. Its clinical presentation often mimics other acute coronary syndromes, making timely recognition challenging. Despite their potential association with adverse cardiovascular events, they are poorly understood and no consensus guideline for their management exists. 64-year-old man with complex medical history including a prior coronary artery disease with stent implantation, who presented with recurrent chest pain. Cardiac catheterization identified a grade II penetrating ulcer of the proximal right coronary artery with no obstructive lesions, and he was subsequently managed conservatively with good outcome.
Discussion:
Penetrating coronary artery ulcers are rare clinical findings with no specific treatment guidelines. Given the limited evidence base and the potential for progression to dissection, thrombosis, or myocardial ischemia, detailed reporting of PCAU presentations is essential to guide clinical practice. Further research is crucial to develop evidence-based treatment guidelines, especially with the advancements in intravascular imaging.
Conclusion:
Penetrating coronary artery ulcer remains a rare but clinically important condition. Early recognition with multimodality imaging and individualized management strategies are key to preventing adverse outcomes. This report expands the existing evidence base and provides valuable reference material for clinicians facing similar scenarios.
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