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Waqas M, Bizzocchi LL, Menegus MA, et al. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus. 2019;11(1):e3928doi: 10.7759/cureus.3928.
Waqas, M., Bizzocchi, L. L., Menegus, M. A., & Faillace, R. T. (2019). Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus, 11(1), e3928. https://doi.org/10.7759/cureus.3928
Waqas, Muhammad, et al. "Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies." Cureus vol. 11,1 (2019): e3928. doi: https://doi.org/10.7759/cureus.3928
Waqas M, Bizzocchi LL, Menegus MA, Faillace RT. Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies. Cureus. 2019 Jan 21;11(1):e3928. doi: 10.7759/cureus.3928. PMID: 30931196; PMCID: PMC6430305.
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Cureus. 2019 Jan 21;11(1):e3928. doi: 10.7759/cureus.3928.

Coronary Artery Ectasia: An Insight into Intraprocedural and Postprocedural Management Strategies.

Cureus

Muhammad Waqas, Lilian L Bizzocchi, Mark A Menegus, Robert T Faillace

Affiliations

  1. Internal Medicine, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA.
  2. Cardiology, Albert Einstein College of Medicine / Jacobi Medical Center, Bronx, USA.

PMID: 30931196 PMCID: PMC6430305 DOI: 10.7759/cureus.3928

Abstract

Coronary artery ectasia (CAE) can present as an acute coronary syndrome (ACS) with a high clot burden in ectatic coronary arteries. Thrombectomy with intracoronary thrombolysis often does not ensure immediate blood flow. Also, there have not been clear guidelines regarding long-term management in such cases. A 40-year-old male presented with anginal chest discomfort and a working diagnosis of non-ST elevation myocardial infarction (NSTEMI) was made. The initial angiography showed thrombotic occlusion of several large and ectatic coronary arteries with visibly swirling blood flow. The culprit lesions were treated with balloon angioplasty and multiple rounds of thrombectomy yielding red thrombi. Interestingly, the post-intervention antegrade flow decreased in both vessels (Thrombolysis in Myocardial Infarction (TIMI) score: 0), possibly because of the distal migration of the clots. Peri-procedure, the patient received two boluses of eptifibatide, 180 mcg/kg each, followed by a continuous infusion of 2 mcg/kg/minute for 18 hours. Afterward, the patient was started on ticagrelor and continued on daily aspirin, high-intensity statin, beta blocker, and Coumadin® with heparin bridge. During the one year follow-up period, the Coumadin was switched to rivaroxaban, ticagrelor was stopped after six months, and the patient was continued on guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) with favorable outcomes. The presented case gives us an insight into not only the intra-procedural but also the post-procedural management of ACS in the setting of CAE, and that is thrombectomy alone followed by longer duration oral anticoagulation in addition to GDMT for CAD. However, it will be interesting to see future studies aimed toward defining the duration as well as the choice of anticoagulation, i.e., dual antiplatelet therapy (DAPT) alone or in combination with warfarin/novel oral anticoagulants (NOACs).

Keywords: acute coronary syndrome; coronary artery ectasia; infarct-related arteries; thrombectomy; thrombolysis; time in therapeutic range

Conflict of interest statement

The authors have declared that no competing interests exist.

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