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Management of Acute Coronary Syndrome in Severe Diffuse Coronary Artery Ectasia: A Therapeutic Challenge
Ahmed Reda Gonnah1, Fahdem Iamrl2, Douglas Jacoby2
1Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Background:
Coronary artery ectasia (CAE) predisposes to abnormal flow, thrombosis, and adverse cardiovascular outcomes.
Case Summary:
A 72-year-old woman with diffuse multivessel CAE, systemic arterial ectasia, and psoriasis presented with inferior ST-segment elevation myocardial infarction in the setting of left bundle branch block. Angiography demonstrated an approximately 8-mm ectatic right coronary artery with complete thrombotic occlusion. Aspiration thrombectomy restored partial flow, but stenting was deferred because of diffuse ectasia, persistent thrombus, and malapposition risk. She was discharged on a direct oral anticoagulant plus single antiplatelet therapy.
Discussion:
Diffuse CAE is a high-risk thrombotic substrate, and ST-segment elevation myocardial infarction management is challenging because of altered flow, large thrombus burden, and percutaneous coronary intervention limitations.
Take-Home Message:
Diffuse systemic ectasia warrants individualized antithrombotic therapy and longitudinal imaging surveillance.
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