Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Department of Cardiology, Sultan Qaboos University Hospital, Muscat, Oman.
Sultan Qaboos Univ Med J. 2020 Nov;20(4):e390-e393. doi: 10.18295/squmj.2020.20.04.018. Epub 2020 Dec 21.
Managing a high intracoronary (IC) thrombus burden is a major challenge in patients with ectatic coronary arteries who present with an ST-elevation myocardial infarction (STEMI). We report a 45-year-old male patient who presented to the Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an inferior STEMI. Coronary angiography revealed ectatic coronary arteries with an occluded right coronary artery (RCA). The RCA had a massive thrombus burden that did not resolve with aspiration thrombectomy or balloon angioplasty. Subsequently, IC thrombolysis was administered resulting in significant reperfusion. During the course of his treatment, the patient suffered from intracranial bleeding as a complication; however, he recovered completely with no residual neurological sequelae. This case report demonstrates that IC thrombolysis is a valid option in patients with a massive thrombus burden in the setting of a STEMI, albeit with an increased risk of major bleeding.
处理冠状动脉（IC）内高血栓负荷是伴发 ST 段抬高型心肌梗死（STEMI）的扩张型冠状动脉患者的主要挑战。我们报告了 1 例 2017 年于阿曼马斯喀特苏丹卡布斯大学医院内科就诊的 45 岁男性患者，其患有下壁 STEMI。冠状动脉造影显示扩张型冠状动脉伴右冠状动脉（RCA）闭塞。RCA 内有大量血栓负荷，抽吸血栓切除术或球囊血管成形术均未能解决。随后给予 IC 溶栓治疗，导致显著再灌注。在治疗过程中，患者发生颅内出血并发症；然而，他完全恢复，没有遗留神经后遗症。本病例报告表明，IC 溶栓治疗对 STEMI 伴大量血栓负荷的患者是有效的选择，尽管有大出血的风险增加。
