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Spontaneous thrombosis in an ectatic right coronary artery
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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.
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 …