A thrombus detachment from the right coronary artery ostium caused cerebral infarction after coronary artery angiography: A case report
Year: 2025
Type: article
Study design: Case Report
Abstract: RATIONALE: Although coronary angiography (CAG) can occasionally lead to cerebral infarction, the detachment of a thrombus from the coronary ostium resulting in blockage of head and neck vessels is rare. We present a case of cerebral infarction caused by thrombus detachment from the right coronary artery (RCA) ostium following CAG. This case underscores the importance of accurate identification and management of coronary ostial thrombus during CAG. PATIENT CONCERNS: A 72-year-old woman was admitted to the hospital with chest pain lasting for 2 hours. DIAGNOSES: Based on the electrocardiogram findings, the patient was diagnosed with an acute inferior ST-Segment Elevation Myocardial infarction accompanied by third-degree atrioventricular block in accordance with established guidelines. INTERVENTIONS: The patient was promptly scheduled for CAG. During RCA angiography, the angiography catheter was inserted into the base of the aortic sinus, and a small volume of contrast agent was injected. The ostium of the RCA was observed to become opacified. However, after the catheter was engaged in the RCA ostium, no further opacification was observed upon contrast injection, and no stenosis was detected in the proximal, middle, or distal segments. We suspected that the thrombus had dislodged. OUTCOMES: The patient's chest symptoms resolved immediately. Moreover, her mental status improved significantly, with normal motor strength and muscle tone in all 4 extremities. However, subsequent computed tomography angiography of the head and neck, cranial magnetic resonance imaging, and magnetic resonance angiography examinations revealed the presence of carotid artery thrombus and acute cerebral infarction. LESSONS: This case underscores the critical importance of accurate identification and management of coronary ostial thrombus during CAG. Notably, when coronary ostial thrombosis is encountered, prompt postprocedural evaluation, including computed tomography angiography of the head and neck to assess for systemic embolization, is warranted.
Source: Medicine
Author: Lingxiao Fang
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,950
OpenAlex ID: W4415828398