Spontaneous thrombosis in an ectatic right coronary artery

Description 

A 73-year-old man presented to our cardiology service with intense central chest pain as an ST-segment elevation myocardial infarction (STEMI) call. His ECG showed inferior ST-segment elevation with reciprocal anterior ST-segment depression. We proceeded directly to coronary angiography which showed an ectatic aneurysmal right coronary artery (RCA) with heavy thrombotic burden (figure 1) but trombolysis in myocardial infarction 3 flow.

Figure 1

Coronary angiogram of the right coronary artery showing an ectatic vessel with a heavy thrombotic burden.

At this point during the procedure, the patient was pain free, and his ST-segment elevation had resolved. As such, we elected to manage him acutely with intravenous unfractionated heparin. Abciximab was considered but given the patient's age, abnormal renal function, normalised ST segments and absence of pain, we elected not to use this therapy acutely. Atrial fibrillation was searched for in...

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