PT  - JOURNAL ARTICLE
AU  - Alejandro Herrera
AU  - Carlos Felipe Matute Martinez
AU  - Juan Fernando Toledo Martinez
AU  - Allan Beall
TI  - Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow
AID  - 10.1136/bcr-2021-245219
DP  - 2021 Nov 01
TA  - BMJ Case Reports
PG  - e245219
VI  - 14
IP  - 11
4099  - http://casereports.bmj.com/content/14/11/e245219.short
4100  - http://casereports.bmj.com/content/14/11/e245219.full
SO  - BMJ Case Reports2021 Nov 01; 14
AB  - 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.