Thromboembolic ST elevation myocardial infarction due to a large coronary aneurysm: Role of apixaban

Özet

Coronary artery aneurysms (CAAs) are generally defined as a localized coronary dilatation exceeding the normal adjacent diameter of the coronary artery by more than 1.5 fold, which is considered as a reference point (1). The prevalence ranges from 1.4% to 4.9% (2) on diagnostic coronary angiography, but aneurysms larger than 8 mm are less frequently described (3). Most patients with CAA are asymptomatic, and the aneurysm is incidentally detected during coronary angiography. Sometimes aneurysm is associated with an acute coronary syndrome due to thrombotic occlusion of the aneurysm or distal embolization. Therapy of patients with large aneurysm associated with acute coronary syndrome is a management dilemma, particularly the choice of antithrombotic therapy because large studies and dedicated guidelines are lacking. In this case report, we describe a patient with ST elevation myocardial infarction due to large coronary aneurysm and distal thromboembolic vessel occlusion treated with balloon coronary angioplasty and dual antithrombotic therapy with clopidogrel and apixaban.