Management of Acute Coronary Syndrome in Severe Diffuse Coronary Artery Ectasia

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-09-11 DOI:10.1016/j.jaccas.2026.110203

Ahmed Reda Gonnah MD, Fahdem Iamrl MD, Douglas Jacoby MD, Allison L. Tsao MD, Mahesh K. Vidula MD, Daniel E. Soffer MD, Monika Sanghavi MD

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Abstract

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.

查看原文本刊更多论文

严重弥漫性冠状动脉扩张急性冠脉综合征的治疗：一个治疗挑战。

背景：冠状动脉扩张（CAE）易导致血流异常、血栓形成和不良心血管结局。病例总结：一名72岁女性，弥漫性多血管CAE，全身动脉扩张，银屑病表现为左束支梗阻下st段抬高型心肌梗死。血管造影显示右冠状动脉扩张约8mm，伴完全血栓闭塞。吸入性取栓恢复了部分血流，但由于弥漫性扩张、持续性血栓和错位风险，支架置入术被推迟。出院时给予直接口服抗凝血药加单一抗血小板治疗。讨论：弥漫性CAE是一种高风险的血栓形成基质，st段抬高型心肌梗死的治疗具有挑战性，因为血流改变、血栓负担大、经皮冠状动脉介入治疗的局限性。关键信息：弥漫性全身扩张需要个体化抗血栓治疗和纵向成像监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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