BMJ Case Reports 2018; doi:10.1136/bcr-2018-224428
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Spontaneous thrombosis in an ectatic right coronary artery

  1. Thomas Kiernan2
  1. 1Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  2. 2Department of Cardiology, University Hospital Limerick, Limerick, Ireland
  1. Correspondence to Napohn Chongprasertpon, napohn{at}
  • Accepted 22 February 2018
  • Published 13 March 2018


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 …

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