PMC5287974_01
Coronary angiography images before thrombus aspirations. A-C, Ectasia of LM, and ectasia and total thrombotic occlusion of the distal LCX. The left anterior descending artery was normal. D, The right coronary artery was normal. LCX = left circumflex artery, LM = left main artery.
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F1
Emergency coronary angiography showed ectasia of left main artery (LM), and ectasia and total thrombotic occlusion of the distal left circumflex artery (LCX) (Fig. 1A-C). There was a large thrombus burden within the CAE segment of the LCX (Fig. 1A-C). The left anterior descending artery (Fig. 1A-C) and right coronary artery (Fig. 1D) were normal.
Angiographic images of the LCX, postthrombus aspirations in (A) right caudal view and (B) antero-posterior caudal view. After several attempted thrombus aspirations, only TIMI 2 flow was restored in the second obtuse marginal branch. The second coronary angiography images of the LCX 15 days after admission in (C) right caudal view and (D) antero-posterior caudal view. There was still an obstructive filling defect in the distal portion of the LCX. TIMI 3 flow was restored in the second obtuse marginal branch. The third coronary angiography images of the LCX 15 months after discharge in (E) right caudal view and (F) antero-posterior caudal view. TIMI 3 flow was restored in the LCX and almost complete resolution of the thrombus was noted. LCX = left circumflex artery, TIMI = thrombolysis in myocardial infarction grade.
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F2
However, the lesion was resistant to repetitive aspirations and the blood flow was only partially restored in the second obtuse marginal branch (OM2) with Thrombolysis In Myocardial Infarction grade (TIMI) 2 flow (Fig. 2A and B). TIMI 3 flow was restored in OM2 (Fig. 2C and D). TIMI 3 flow was observed (Fig. 2E and F). Therefore, long-term oral anticoagulation with warfarin was prescribed for outpatient follow-up.
Sixty-four-slice coronary computed tomographic angiography images of the LCX 10 days after admission. A and B, Three-dimensional computed tomography reconstruction showing coronary artery ectasia involving the LM and LCX. C and D, A filling defect is shown in the distal portion of the LCX (arrow). LCX = left circumflex artery, LM = left main artery.
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F3
Coronary computed tomographic angiography 10 days after admission showed CAE involving the LM and LCX and confirmed the presence of an occlusive intraluminal thrombus in the distal portion of the LCX (Fig. 3).