CASE REPORT article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1631992
This article is part of the Research TopicCase Reports in Coronary Artery Disease: 2025View all 8 articles
A "giant bomb" in acute myocardial infarction due to coronary artery aneurysm: a case report
Provisionally accepted
- 1Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Zhangjiagang, China
- 2Zhangjiagang City Hospital of Traditional Chinese Medicine attached to Jiangsu Institute of Vocational Medicine, Jiangsu, China
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Background: Coronary artery aneurysm associated with acute coronary syndromes represents a rare clinical entity, particularly in cases with persistent significant thrombus burden following aspiration therapy. The novel pathomechanism of intra-aneurysmal thrombosis secondary to pathological flow dynamics-characterized by endothelial shear stress perturbation and blood stasis-has been rarely documented. While existing literature describes therapeutic applications of surgical repair, percutaneous intervention, and pharmacotherapy in coronary artery aneurysm management, no consensus-driven protocol has been established, reflecting critical knowledge gaps in risk-stratified treatment algorithms for thrombus-laden aneurysms. Case outline: A 51-year-old female presenting with acute ST-segment elevation myocardial infarction underwent emergency coronary angiography, revealing a large right coronary artery aneurysm with significant intra-aneurysmal thrombus burden. Despite successful thrombus aspiration restoring distal TIMI 3 flow, persistent residual thrombus within the aneurysmal segment prompted the selection of intensified anticoagulation combined with dual antiplatelet therapy over percutaneous intervention. Throughout the therapeutic course, the patient remained asymptomatic without recurrent angina. Follow-up angiography performed after 7 days of targeted antithrombotic therapy demonstrated near-complete resolution of the intra-aneurysmal thrombus, accompanied by preserved coronary flow and no evidence of distal embolization.We present a rare case of ST-segment elevation myocardial infarction complicated by a coronary artery aneurysm, highlighting the therapeutic challenges in managing such complex pathologies. While intensified anticoagulation combined with dual antiplatelet therapy constitutes a clinically valid approach, the absence of consensus guidelines results in significant variability in treatment protocols. This case underscores the urgent need for large-scale multicenter studies to establish evidence-based management strategies for patients with coronary artery aneurysm associated with acute coronary syndromes.
Keywords: coronary artery aneurysm, Acute Coronary Syndromes, Thrombosis, anticoagulation, case report
Received: 21 May 2025; Accepted: 27 Jun 2025.
Copyright: © 2025 Chen, Du, Jiang and Xu. 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: Liugang Xu, Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Zhangjiagang, 210023, China
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