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Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow
  1. Alejandro Herrera1,
  2. Carlos Felipe Matute Martinez1,
  3. Juan Fernando Toledo Martinez2 and
  4. Allan Beall3
  1. 1Internal Medicine, Texas Tech University Health Sciences Center School of Medicine, Odessa, Texas, USA
  2. 2Universidad Católica de Honduras Nuestra Señora Reina de la Paz, Facultad de medicina y cirugia, San Pedro Sula, Honduras
  3. 3Interventional Cardiology Department, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Carlos Felipe Matute Martinez; carlosfmatute{at}


A coronary artery aneurysm (CAA) is an uncommon clinical finding with an incidence of <5% in adults. The presence of a large intracoronary thrombus within an aneurysmal coronary artery and normal coronary flow is usually a very challenging case scenario. Here, we present a case of a patient presenting with typical chest pain symptoms, high-risk findings on a pharmacological nuclear stress test and coronary angiogram showing severe multivessel coronary artery disease, including a large aneurysmal segment within the proximal left anterior descending artery with a large thrombus that did not affect intracoronary flow. Today, there are no published guidelines for the management of CAA with a normal intracoronary flow. The approach used in this case was initial antithrombotic therapy followed by a successful staged percutaneous coronary intervention. Here, we present a case supporting the use of combined intravenous anticoagulant and antiplatelet therapy for 48 hours, followed by successful percutaneous intervention guided by intravascular ultrasound.

  • cardiovascular medicine
  • interventional cardiology
  • pericardial disease

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  • Contributors AH, CFMM, JFTM and AB contributed to all the parts of the manuscript, including planning, design, data collection, analysis of data, drafting and revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.