Massive thrombus over an aneurysmatic left main coronary artery: Non-interventional therapy?

array:23 ["pii" => "S0870255121002420" "issn" => "08702551" "doi" => "10.1016/j.repc.2020.07.023" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "1759" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2021;40:699-700" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0870255121002432" "issn" => "08702551" "doi" => "10.1016/j.repc.2020.09.013" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "1760" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2021;40:701-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Image in Cardiology" "titulo" => "Intracavitary mass in echocardiography: A rare manifestation of serous ovarian carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "701" "paginaFinal" => "702" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Massa intracavitária na ecocardiografia: uma manifestação rara de carcinoma seroso de ovário" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2845 "Ancho" => 1675 "Tamanyo" => 423717 ] ] "descripcion" => array:1 [ "en" => "A: Transthoracic echocardiography showing echo-dense mass of 32 mm×31 mm, area 9.8 cm2 within right atrium suggestive of mass or intracavitary thrombus (white arrow). C: Transthoracic echocardiography showing mass within right atrium (white arrow). B: Transthoracic echocardiography showing restriction to color flow Doppler (white arrow)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Arnold Mendez-Toro, Andres Felipe Linares-Vaca" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Arnold" "apellidos" => "Mendez-Toro" ] 1 => array:2 [ "nombre" => "Andres Felipe" "apellidos" => "Linares-Vaca" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121002432?idApp=UINPBA00004E" "url" => "/08702551/0000004000000009/v1_202109020549/S0870255121002432/v1_202109020549/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0870255121002705" "issn" => "08702551" "doi" => "10.1016/j.repc.2021.03.008" "estado" => "S300" "fechaPublicacion" => "2021-09-01" "aid" => "1778" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2021;40:697.e1-697.e4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "Commentary" "titulo" => "2020 European Society of Cardiology Core Curriculum for the Cardiologist. Is it time for change in the Portuguese cardiology training program?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "697.e1" "paginaFinal" => "697.e4" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Currículo Europeu de Cardiologia – edição de 2020 Chegou a altura de rever o programa de formação em cardiologia português?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Kevin Domingues, Lino Gonçalves, Maria João Vidigal, Felix C. Tanner, Miguel Mendes" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Kevin" "apellidos" => "Domingues" ] 1 => array:2 [ "nombre" => "Lino" "apellidos" => "Gonçalves" ] 2 => array:2 [ "nombre" => "Maria João" "apellidos" => "Vidigal" ] 3 => array:2 [ "nombre" => "Felix C." "apellidos" => "Tanner" ] 4 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121002705?idApp=UINPBA00004E" "url" => "/08702551/0000004000000009/v1_202109020549/S0870255121002705/v1_202109020549/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Image in Cardiology" "titulo" => "Massive thrombus over an aneurysmatic left main coronary artery: Non-interventional therapy?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "699" "paginaFinal" => "700" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Kristian Rivera, Diego Fernández-Rodríguez, Marta Zielonka, Juan Casanova-Sandoval" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Kristian" "apellidos" => "Rivera" "email" => array:1 [ 0 => "kristianrivera@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Diego" "apellidos" => "Fernández-Rodríguez" ] 2 => array:2 [ "nombre" => "Marta" "apellidos" => "Zielonka" ] 3 => array:2 [ "nombre" => "Juan" "apellidos" => "Casanova-Sandoval" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, University Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Trombo massivo num tronco coronário esquerdo aneurismático: terapia não intervencionista?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1062 "Ancho" => 1305 "Tamanyo" => 212711 ] ] "descripcion" => array:1 [ "en" => "Baseline and follow-up angiographies and intravascular ultrasound. (A, B) Baseline coronary angiography showed a coronary mass in distal left main coronary artery (white asterisks); Online-Video 1. (C-D) Baseline intravascular ultrasound showed a large intraluminal mass, presenting a variable gray scale with speckling, suggestive of thrombus. (E-G) Progressive and complete thrombus dissolution on coronary angiographies; Online-Video 2-4. (H-J) Final intravascular ultrasound demonstrated the absence of thrombus and atherosclerotic disease." ] ] ] "textoCompleto" => "We report the case of a 69-year-old man, a former smoker with hypertension, who underwent emergent coronary angiography after an anterior ST-segment elevation myocardial infarction (STEMI). Pre-treatment with aspirin, clopidogrel and un-fractioned heparin (UFH) was administered. Coronary angiography revealed a large contrast filling defect at the distal segment of aneurysmatic left main coronary artery (LMCA) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A-1B, Online-Video 1). An intravascular ultrasound (IVUS) was performed to assess the intracoronary mass, showing a large LMCA thrombosis without underlying coronary plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C-1D).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Intracoronary half-dose of tenecteplase and abciximab was administered. After initial management, an aggressive in-hospital antithrombotic strategy with aspirin, ticagrelor and intravenous UFH was followed. A total of three serial coronary angiographies were performed over the next two weeks, showing a progressing reduction of thrombus burden until there was complete dissolution (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E, 1F, 1G, Online-Video 2-4). Finally, IVUS reconfirmed the absence of coronary parietal disease (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>H-1J). Patient was discharged under aspirin, clopidogrel and acenocumarol for one month, followed by aspirin and acenocumarol. Twelve months later, the patient remained asymptomatic without bleeding events.Restoring coronary flow and avoiding distal embolization are the two major goals in STEMI. Nevertheless, the management of massive coronary thrombosis in aneurysmatic arteries is challenging due to the high risk of non-reflow and embolization associated with coronary manipulation, in addition to the risk of in-stent thrombosis and/or restenosis due to a probable scaffold malapposition in the future. We note that our case shows that an aggressive antithrombotic regimen could represent a successful strategy in these patients if coronary flow is preserved, even in LMCA thrombosis.Conflicts of interestThe authors have no conflicts of interest to declare." 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