case_images: PMC10894723_01
case_images: Electrocardiogram of the patient. (A) On admission. (B) After thrombosuction and balloon angioplasty of RCA. (C) After PCI (on the ninth day). (D) After 12 months. PCI: percutaneous coronary intervention; RCA: right coronary artery
case_images: cureus-0016-00000053010-i01.jpg
case_images: PMC10894723_01_cureus-0016-00000053010-i01.jpg
case_images: FIG1
case_images: The patient remained asymptomatic without antiplatelets until November 19, 2022 (12.3 years after stent implantation), when he presented complaining of chest heaviness one hour prior, and ECG showed ST elevation in lead II, III, aVF, and ST depression in V2-V6, lead I, aVL (Figure 1A).
case_images: Coronary angiogram of the patient. A) Nonsignificant lesion of LAD and LCx (<50% stenosis as measured with QCA). (B) Proximal complete occlusion of RCA (small arrow) due to thrombus in the stent (white arrow). (C) The RCA after thrombosuction and balloon angioplasty with restored TIMI 2 flow and diffuse lesions. LAD: left anterior descending coronary artery; LCx: left circumflex coronary artery; QCA: quantitative coronary angiography; RCA: right coronary artery; TIMI: Thrombolysis in Myocardial Infarction
case_images: cureus-0016-00000053010-i02.jpg
case_images: PMC10894723_01_cureus-0016-00000053010-i02.jpg
case_images: FIG2
case_images: His emergency coronary angiogram showed acute occlusion of proximal RCA with a moderate thrombus burden (Figure 2B) and nonsignificant lesions of other vessels (Figure 2A). Thrombolysis in Myocardial Infarction (TIMI) 2 flow was restored, and diffuse lesions in RCA were observed (Figure 2C). The door-to-balloon time was four hours.
case_images: Stent placement. (A) RCA before stent placement. (B) Stent placement in the mid-RCA (black arrow). RCA: right coronary artery
case_images: cureus-0016-00000053010-i03.jpg
case_images: PMC10894723_01_cureus-0016-00000053010-i03.jpg
case_images: FIG3
case_images: A repeated coronary angiogram after nine days on antithrombotic drugs revealed less in-stent thrombus and only one significant lesion in mid-RCA (Figure 3A). The RCA was stented with one second-generation everolimus-eluting stent (2.75 x 23 mm) (Figure 3B).