PMC8086688_01
Extensive coronary erosion after cocaine, treated with branch-per-branch thrombus aspiration.
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The coronary angiogram (44' after onset of symptoms) showed occlusion of the right coronary artery (RCA), with a narrowing in its mid portion (Fig. 1A, asterisk) and contrast retention in the posterior descending (PD) (Fig. 1A, white arrow, Suppl. Thrombus aspiration in RCA and PD was performed with an ASAP catheter (Merit Medical, South Jordan, UT), thus restoring Thrombolysis in Myocardial Infarction (TIMI)-3 flow in the PD but not in the atrioventricular artery (Fig. 1B, Suppl. Optical coherence tomography showed thrombus remnants at the narrowing (Fig. 1C, asterisk, Suppl. Video 3) in an otherwise non-atherosclerotic, 3-layered vessel without evidence of plaque rupture (Fig. 1C), i.e. an erosion. Three-dimensional image fusion depicted an extensive coronary erosion at the inner curvature of the RCA, with varying amounts of thrombotic burden (Fig. 1D, E), extending from the take-off of the acute marginal to the proximal RCA, in contrast with the smooth appearance of the outer curvature of the same segment (Fig. 1F). Cross-sections (Fig. 1G, H, I) show coronary erosion (left side) as opposed to the smooth healthy sectors (right side). Video 4) until final TIMI-3 flow was restored in all territories (Fig. 1J, Suppl.