CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1595445
This article is part of the Research TopicCase Reports in Coronary Artery Disease: 2025View all 13 articles
Case Report: Rescue thrombolysis after failed primary percutaneous coronary intervention in coronary artery ectasia with ST-elevation myocardial infarction
Provisionally accepted
- Peking Union Medical College Hospital (CAMS), Beijing, China
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Background: Coronary artery ectasia (CAE) is a rare disease characterized by pathological ectasia of the coronary artery. In the setting of ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) of the ectatic culprit vessel is less likely to succeed due to significant thrombus burden and tortuous ectatic coronary anatomy. However, there are currently no clinical guidelines for subsequent treatment when primary PCI fails. We present a case of successful revascularization by rescue thrombolysis after failed primary PCI in a CAE patient presenting with STEMI. Case presentation: A 63-year-old male presented with a four-hour history of typical rest angina and electrocardiographic findings of inferior ST-segment elevation was diagnosed with acute inferior STEMI. Emergency coronary angiography revealed a complete mid-segment occlusion of the right coronary artery (RCA) and abnormal ectasia of the three main coronary arteries. Multiple attempts to cross the lesion with a guidewire were unsuccessful, leading to the termination of primary PCI. Subsequently, rescue thrombolysis was administered, and repeat angiography confirmed recanalization of the RCA. Discussion: This case is the first to highlight the potential benefit of timely rescue thrombolysis in CAE patients with STEMI when primary PCI fails. It provides useful clinical insight into the management of this high-risk subset of STEMI patients.
Keywords: rescue thrombolysis, Percutaneous Coronary Intervention, ST-elevation myocardial infarction, Coronary artery ectasia, case report
Received: 18 Mar 2025; Accepted: 04 Sep 2025.
Copyright: © 2025 Sun, Tang, Zhang, Yang, Shen, Tian and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ran Tian, Peking Union Medical College Hospital (CAMS), Beijing, China
Zhenyu Liu, Peking Union Medical College Hospital (CAMS), Beijing, China
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