TY - JOUR T1 - Management of a large intraluminal thrombus in an aneurysmal coronary segment with normal coronary flow JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2021-245219 VL - 14 IS - 11 SP - e245219 AU - Alejandro Herrera AU - Carlos Felipe Matute Martinez AU - Juan Fernando Toledo Martinez AU - Allan Beall Y1 - 2021/11/01 UR - http://casereports.bmj.com/content/14/11/e245219.abstract N2 - 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. ER -