A Case Report of Successful Fibrinolysis in a Multiple Coronary Ectasia ST-segment Elevation Myocardial Infarction Validated by Coronary Angiography
Muneera AlTaweel *
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia and King Abdullah International Medical Research Center (KAIMRC), Al Ahsa, Saudi Arabia
Sarah AlSulaiman
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Sarah AlMukhaylid
College of Applied Medical Sciences (CoAMS-A), King Saud Bin Abdulaziz University for Health Sciences -KAIMRC/ KAH, National Guard Health Affairs, Al-Ahsa, Saudi Arabia and King Abdullah International Medical Research Center (KAIMRC), Al Ahsa, Saudi Arabia.
Fahad Memon
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Faisal AlAnazi
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Waleed Gado
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Tarek Naseef
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Munirah AlMakhayitah
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Mohannad Alokifi
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Abdulaziz Alazmi
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Asma Alismail
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
Nada Alsultan
King Abdulaziz Hospital, MNGHA, Al Ahsa, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Coronary artery ectasia (CAE) often presents in the form of an acute coronary syndrome (ACS) caused by slow blood flow leading to thrombus formation in ectatic coronary arteries. The usual approach is thrombectomy with intracoronary thrombolysis but often does not guarantee immediate blood flow. A 45-year-old male presented with anginal chest pain and was diagnosed with ST-segment elevation myocardial infarction (STEMI), managed Immediately with tissue plasminogen activator(t-PA) followed later with coronary angiography revealing diffused Multiple coronary ectasia MCEA with no identified culprit lesions afterward. The patient was followed up periodically, with favorable outcomes on daily aspirin, direct oral anticoagulant (DOAC), and guideline-directed medical therapy (GDMT) for coronary artery disease (CAD) and reduced ejection fraction heart failure (HF-rEF). This case management strategy was dictated by available resources at the time of presentation; however, it signifies the importance and favorable outcome of thrombolysis in CEA/STEMI patients. Future large-scale studies are required toward defining the duration as well as the choice of long-term anticoagulation.
Keywords: Coronary artery ectasia, ST-segment elevation myocardial infarction, Fibrinolysis, Thrombolysis