case_images: PMC11160384_01
case_images: (A) Acute thrombotic occlusion of first diagonal (D1 vessel (white arrow). (B) Coronary guidewires advanced into distal vessels and balloon angioplasty performed delineating the vessel and revealing a large thrombus burden (white arrows). (C) Aspiration thrombectomy with large thrombus retrieval. (D) Angiography after intracoronary tissue plasminogen activator and Abciximab revealed partial thrombus resolution but still with a mobile thrombus (white arrow).
case_images: mdcvj-20-1-1343-g1.jpg
case_images: PMC11160384_01_mdcvj-20-1-1343-g1.jpg
case_images: F1
case_images: Coronary angiography revealed an acute thrombotic occlusion of the first diagonal (D1) branch supplying a large territory of the anterolateral wall (Figure 1A). Also noted were the aneurysmal left anterior descending (LAD) artery (Figure 1A) and an ectatic codominant right coronary artery (RCA). Subsequent angiography revealed a large thrombus burden (Figure 1B). At this point, an 80% stenosis was noted in the proximal diagonal artery right after the takeoff from the aneurysmal proximal LAD segment (Figure 1D). Subsequent angiography revealed a partial resolution albeit with a mobile thrombus in the first diagonal branch (Figure 1D).
case_images: (A) Angiography 48 hours later showed near thrombus resolution. (B) Intravascular ultrasound of the mid-left anterior descending artery (C) and first diagonal branch (D1) showed minimal lumen area of 3.7 mm2 and 3.4 mm2, respectively. (D) Simultaneous kissing stent placement in the left anterior descending artery and the D1 branch. (E, F) Final angiography revealed thrombolysis in myocardial infarction-3 flow and no residual stenosis.
case_images: mdcvj-20-1-1343-g2.jpg
case_images: PMC11160384_01_mdcvj-20-1-1343-g2.jpg
case_images: F2
case_images: Intravascular ultrasound (IVUS) of the D1 and the mid LAD was performed, and the minimal luminal area was noted to be 3.7 mm2 and 3.4 mm2, respectively (Figure 2B, C). Stents were placed in the mid-LAD and the D1 vessels (Figure 2D).
case_images: PMC11160384_02
case_images: (A) Aneurysm of the proximal left anterior descending artery (LAD) with acute thrombotic occlusion of the mid-LAD with thrombolysis in myocardial infarction (TIMI)-0 flow distally. (B) Stent placement. (C, D) Successful revascularization with restoration of TIMI-3 flow. (E,F) Aneurysm in the proximal right coronary artery (RCA) with no significant disease. Mid-RCA had a focal 90% lesion with a tortuous course afterwards and TIMI-3 flow distally.
case_images: mdcvj-20-1-1343-g3.jpg
case_images: PMC11160384_02_mdcvj-20-1-1343-g3.jpg
case_images: F3
case_images: TIMI-0 flow distally (Figure 3A). The proximal circumflex artery (LCX) was also aneurysmal, without any angiographically significant coronary disease in the LCX and the first obtuse marginal artery (Figure 3A). Mid-RCA had a focal 90% lesion with a tortuous course afterward and TIMI-3 flow distally (Figure 3E, F).
case_images: PMC11160384_03
case_images: (A) Aneurysmal dominant right coronary artery (RCA) with a large thrombus burden and a thrombotic occlusion of the mid RCA. (B, C) Aspiration thrombectomy achieving only partial flow in the distal vessel.
case_images: mdcvj-20-1-1343-g4.jpg
case_images: PMC11160384_03_mdcvj-20-1-1343-g4.jpg
case_images: F4
case_images: Coronary angiography revealed aneurysmal RCA thrombotic occlusion of the mid-RCA (Figure 4A). Aspiration thrombectomy was performed using an export catheter with large thrombus retrieval (Figure 4B, C).