Progressive Dilation of Coronary Artery Ectasia Causing Recurrent Myocardial Infarction (JACC Case Reports October 2023)-Article: Progressive Dilation of Coronary Artery Ectasia Causing Recurrent Myocardial Infarction

Article: Progressive Dilation of Coronary Artery Ectasia Causing Recurrent Myocardial Infarction

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This case report describes a 64-year-old woman with a history of hypertension, diabetes mellitus, and dyslipidemia, who presented with recurrent myocardial infarction (MI) due to progressive dilation of coronary artery ectasia (CAE). The initial coronary angiography revealed an ectatic right coronary artery (RCA) with occlusion of the distal vessel. The left coronary artery was also ectatic with slow flow but no evidence of stenosis or thrombus. The patient was treated initially with antithrombotic therapy and maintained on long-term warfarin monotherapy, which was later changed to edoxaban.<br /><br />Fifteen years later, the patient was admitted with sudden-onset chest pain and ST-segment elevation on electrocardiography. Coronary angiography showed occlusion of the mid-RCA with a substantial thrombus burden. The ectatic morphology of the RCA had significantly enlarged compared to the previous examination. Emergency primary percutaneous coronary intervention (PCI) was performed, and a drug-eluting stent was implanted in the focal stenosis. Despite remaining thrombi in the surrounding segments, further intervention with additional stenting was deemed unsuitable due to the ectatic morphology.<br /><br />Follow-up imaging showed a patent RCA with minimal residual thrombus. The patient was discharged on warfarin and prasugrel and remained free from recurrence of MI or any bleeding events at the 12-month follow-up.<br /><br />This case highlights the need for comprehensive investigation and management of CAE, including consideration of underlying causes, appropriate antithrombotic therapy, and regular follow-up. The progressive dilation of the RCA emphasizes the importance of closely monitoring these patients and conducting morphologic evaluations to detect any progressive disease and prevent recurrent MIs. The optimal treatment strategy for thrombotic occlusion in advanced CAE remains uncertain, and further research is needed to establish best practices.

Keywords

coronary artery ectasia

myocardial infarction

antithrombotic therapy

warfarin

edoxaban

percutaneous coronary intervention

thrombus

follow-up

morphologic evaluations

treatment strategy