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冠状动脉瘤血栓形成导致的心肌梗死伴非阻塞性冠状动脉病变

MINOCA as the result of coronary artery aneurysm thrombosis.

作者信息

Rokyta Oksana

机构信息

Department of Internal Medicine No. 2, Bogomolets National Medical University, Kyiv, Ukraine.

出版信息

J Int Med Res. 2024 Dec;52(12):3000605241301859. doi: 10.1177/03000605241301859.

Abstract

Myocardial infarction (MI) can be caused by many factors. In addition to the typical obstruction or stenosis of the coronary arteries, there is heterogenic MI with non-obstructive coronary arteries (MINOCA). A rare cause of MINOCA is the thrombosis of a coronary artery aneurysm (CAA). This current case report describes a male patient with CAA thrombosis as the cause of MINOCA following surgery for a mucoepidermoid carcinoma. The patient underwent angiography that identified three CAAs that were located as follows: (i) in the proximal part of the left anterior descending artery (5.55 mm); (ii) in the distal part of the circumflex artery (8.05 mm); and (iii) in the distal part of the right coronary artery (6.61 mm). Thrombotic masses were identified within all three structures. The patient received balloon angioplasties without stent implanting and recovered well. The patient was also notable for the presence of two brain artery aneurysms that were the cause of the previous strokes that he had experienced. This case report also reviews the literature in order to: (i) summarize the aetiological factors and clinical manifestations of CAA; (ii) discuss the diagnostic methods for CAA; (iii) describe the medical and surgical management of CAA; and (iv) assess the prognosis of this rare clinical event.

摘要

心肌梗死(MI)可由多种因素引起。除了典型的冠状动脉阻塞或狭窄外,还存在冠状动脉无阻塞性的异质性心肌梗死(MINOCA)。MINOCA的一种罕见病因是冠状动脉瘤(CAA)血栓形成。本病例报告描述了一名男性患者,其CAA血栓形成是黏液表皮样癌手术后MINOCA的病因。患者接受了血管造影,发现了三个冠状动脉瘤,位置如下:(i)左前降支近端(5.55毫米);(ii)回旋支远端(8.05毫米);(iii)右冠状动脉远端(6.61毫米)。在所有三个结构内均发现了血栓块。患者接受了未植入支架的球囊血管成形术,恢复良好。该患者还因存在两个脑动脉瘤而引人注目,这两个脑动脉瘤是他之前中风的原因。本病例报告还回顾了文献,以便:(i)总结CAA的病因和临床表现;(ii)讨论CAA的诊断方法;(iii)描述CAA的内科和外科治疗;(iv)评估这一罕见临床事件的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e0b2/11632892/5f1251fcf9e5/10.1177_03000605241301859-fig1.jpg

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