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Case Reports: Unusual presentation of more common disease/injury
Minimally invasive treatment of left main coronary artery thrombosis in a young patient with COVID-19
  1. Jacob Johnsen1,2,
  2. Steen Dalby Kristensen1,2 and
  3. Nicolaj Brejnholt Støttrup1,2
  1. 1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Jacob Johnsen; jacob.johnsen{at}clin.au.dk

Abstract

COVID-19 has been associated with cardiovascular events. This case demonstrates severe left main coronary artery thrombosis with distal embolisation in a young male patient admitted with COVID-19 who developed ST-elevation myocardial infarction. The patient was treated with thrombus aspiration combined with aggressive anticoagulant treatment, which yielded complete resolution of the thrombus. Left main thrombus represents a life-threatening coronary event and is most often associated with atherosclerotic plaque rupture. In this case, however, we suspect that COVID-19-related intimal inflammation and hypercoagulopathy might be the causal mechanism of thrombus formation. Revascularisation with coronary artery bypass grafting or percutaneous coronary intervention is the standard treatment of left main thrombosis. However, due to the patient’s young age and lack of significant atherosclerotic disease burden, we used a conservative medical treatment strategy using potent antithrombotic therapy.

  • Interventional cardiology
  • Ischaemic heart disease
  • COVID-19

https://doi.org/10.1136/bcr-2022-250011

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    Footnotes

    • Contributors All authors were involved in the acute management of the patient and contributed to the writing and editing of this paper. JJ, NBS and SDK were all involved in the planning of this case report. JJ and NBS wrote the initial manuscript draft. JJ was involved in the initial diagnosis and treatment. NBS and SDK performed the angiographies and decided on the selected treatment strategy.

    • 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.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

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